Fusion · Wrist

Limited wrist arthrodesis (intercarpal or radiocarpal fusion) performed with autograft harvested during the same surgical session.

Verified May 8, 2026 · 7 sources ↓

Medicare: $743.84
Total RVUs: 22.27
Global, days: 90
Region: Wrist

Drawn from AAPCHopkinsmedicineNIHCMSEatonhand

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 7 cited references ↓

Operative note must name the specific fusion performed (e.g., four-corner fusion, scapholunate fusion) — 'limited wrist fusion' alone is insufficient.
Confirm and document that the fusion is limited (intercarpal or radiocarpal subset only) and does not include radius-to-carpus fusion, which would indicate a complete arthrodesis.
Document autograft source (e.g., distal radius, iliac crest) and harvest technique; graft harvest is bundled, but the source must appear in the note.
Record fixation hardware used (headless screws, K-wires, plate-and-screw construct) and number of joints fused.
ICD-10 diagnosis code must establish medical necessity — most payers require documented failure of conservative treatment prior to arthrodesis approval.
If a scaphoidectomy was performed and the excised scaphoid was used as autograft, document the surgical rationale; NCCI bundling of the scaphoidectomy is expected when the excised bone serves as the graft source.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 25825 covers a limited wrist arthrodesis — a partial fusion of the carpal bones — performed using bone graft taken from the patient's own body during the same operative encounter. The graft harvest is bundled into this code; do not separately bill a graft-harvesting code. Limited fusions include procedures such as four-corner fusion, scapholunate fusion, and four-corner fusion with scaphoidectomy. All of these fuse a subset of the carpal bones rather than the entire wrist joint.

Distinguishing 25825 from its neighbors is critical. Use 25820 when the limited fusion is performed without any graft. Use 25810 when the fusion is complete (radiocarpal joint included) and an autograft is used — that code covers full wrist fusion with iliac or other autograft. Use 25800 or 25805 for complete fusions without autograft or with a sliding graft, respectively. If the operative note describes fusion of the radius to the carpal bones, that is a complete arthrodesis, not a limited one — 25825 is the wrong code.

The 90-day global period applies. All routine post-op wrist management, dressing changes, and hardware checks through day 90 are included. Unrelated problems treated in that window require modifier 24 on the E/M. This code carries site-of-service implications: payers including Johns Hopkins Health Plans designate 25825 as an outpatient surgery requiring prior authorization at hospital-based outpatient facilities but not at freestanding ASCs — verify prior auth requirements before scheduling.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.45
Practice expense RVU	11.03
Malpractice RVU	1.79
Total RVU	22.27
Medicare national rate	$743.84
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$743.84
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,708.07

Common denial reasons

The recurring reasons claims for CPT 25825 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Wrong code selected — using 25825 when the fusion included the radiocarpal joint, which maps to 25810 (complete arthrodesis with autograft).
Missing prior authorization — several payers, including certain Blue Cross plans, require PA for 25825 at hospital-based outpatient facilities.
Insufficient medical necessity documentation — no documented trail of failed conservative treatment (splinting, injections, therapy) before arthrodesis.
Graft harvest billed separately in addition to 25825, triggering NCCI bundling denial.
Operative note describes only 'standard limited wrist fusion' without naming the specific intercarpal joints fused, leading to medical review or downcoding.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What is the difference between 25825 and 25810?

25825 is for limited wrist arthrodesis with autograft — only a subset of the carpal bones is fused. 25810 covers complete wrist arthrodesis with autograft, meaning the radius is fused to the carpal bones. If the radiocarpal joint is included in the fusion, use 25810.

02Is the autograft harvest separately billable with 25825?

No. The code descriptor explicitly includes obtaining the graft. Billing a separate graft-harvesting code alongside 25825 will trigger an NCCI bundling denial.

03Can a four-corner fusion with scaphoidectomy be billed as 25825?

Yes, when an autograft is used. The scaphoidectomy is typically bundled, particularly when the excised scaphoid serves as the autograft source. Document the surgical rationale clearly in the operative note.

04Does 25825 require prior authorization?

Payer-variable. Johns Hopkins Health Plans and similar managed care payers require PA for 25825 at hospital-based outpatient facilities but not at freestanding ASCs as of October 1, 2025. Verify with each payer before scheduling.

05What global period applies to 25825?

90-day global period. Routine post-op visits, dressing changes, and hardware checks through day 90 are bundled. Bill unrelated E/M services in that window with modifier 24; unrelated surgical procedures need modifier 79.

06Which ICD-10 codes support medical necessity for 25825?

Carpal instability, post-traumatic wrist arthritis, Kienböck's disease, and scapholunate advanced collapse (SLAC wrist) are common supporting diagnoses. Many payers require documented failure of prior non-surgical treatment, so ensure the chart reflects that history.

07When is modifier 22 appropriate on a 25825 claim?

Use modifier 22 when the procedure required substantially more work than typical — for example, severe post-traumatic deformity requiring extensive bone preparation, hardware removal from prior surgery, or complex graft shaping. The operative note must explicitly describe the additional time and effort; a generic 'difficult case' notation will not support the modifier.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the specific joints fused (e.g., capitate-lunate-triquetrum-hamate for four-corner fusion), autograft harvest site, fixation hardware, and explicit confirmation that the radiocarpal joint was not included. That documentation is what separates a clean 25825 claim from a miscoded 25810 or a medical-review flag — and it's the exact language payers audit when questioning whether the fusion was truly limited.

See how Mira captures CPT 25825 documentation