Fusion · Wrist

Fusion of the distal radioulnar joint combined with segmental resection of the ulna, with or without bone graft — the Sauvé-Kapandji procedure.

Verified May 8, 2026 · 6 sources ↓

Medicare: $970.63
Total RVUs: 29.06
Global, days: 90
Region: Wrist

Drawn from CMSAAPCPayerpriceCgsmedicareGenhealth

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the diagnosis driving the procedure (e.g., post-traumatic DRUJ arthritis, DRUJ instability, rheumatoid arthritis)
Document the surgical approach by name and location of incision over the DRUJ
Record the measured length of the ulnar segment resected
Specify whether bone graft was used, the graft type (autograft, allograft), and harvest site if autograft
Document fixation construct at the DRUJ (e.g., K-wires, screws, plate) and intraoperative stability assessment
Note intraoperative fluoroscopy use and confirm radiographic alignment if applicable
Preoperative imaging (X-ray or CT) in the record confirming DRUJ pathology

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25830 describes the Sauvé-Kapandji procedure: the distal radioulnar joint (DRUJ) is fused while a segment of the distal ulna proximal to the fusion is resected, creating a pseudarthrosis that preserves forearm rotation. A bone graft may be used to facilitate fusion at the DRUJ. The procedure addresses chronic DRUJ instability, post-traumatic arthritis, rheumatoid arthritis-related DRUJ destruction, or failed prior DRUJ procedures. Both the fusion and the segmental ulnar resection are integral to this code — do not unbundle them.

The 90-day global period covers the surgery, the day-before preoperative visit, and all routine postoperative care through day 90. Any visit or procedure unrelated to the DRUJ fusion during the global window requires modifier 24 (E/M) or 79 (unplanned unrelated procedure). A return to the OR for a complication directly related to the fusion — such as fixation failure — uses modifier 78.

Document the approach, the extent of ulnar resection (segment length), whether bone graft was harvested and from which site, fixation method used at the DRUJ, and the intraoperative stability assessment. Revision cases involving pseudarthrosis of a prior arthrodesis are still coded from the 25800–25830 family; hardware removal that is part of the revision is included and not separately reportable.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.61
Practice expense RVU	16.37
Malpractice RVU	2.08
Total RVU	29.06
Medicare national rate	$970.63
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	$970.63
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 25830 get rejected.

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

Operative note describes only joint fusion without documenting segmental ulnar resection, misaligning with 25830 descriptor
Bone graft harvest (e.g., iliac crest) billed separately when it is included in 25830
Hardware removal billed separately during a revision case when it is bundled into the arthrodesis
Laterality modifier (LT or RT) missing on claims where payer requires it for unilateral upper extremity procedures
ICD-10 diagnosis code does not support DRUJ pathology (e.g., a wrist fracture-only code submitted without an arthritis or instability code when clinically appropriate)

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Is bone graft harvest separately billable with 25830?

No. The code descriptor explicitly includes 'with or without bone graft,' so the graft work — whether local or from a distant site — is bundled. Bill only 25830 regardless of whether a graft was taken.

02Can hardware removal be billed separately if screws from a prior fusion are removed during a revision with 25830?

No. Per coding guidance in the 25800–25830 family, hardware removal that is part of the arthrodesis revision is included in the arthrodesis code and is not separately reportable.

03What modifier is required when billing 25830 during the 90-day global of a prior wrist procedure?

Use modifier 79 if the DRUJ fusion is unrelated to the prior procedure. Use modifier 78 only if it is a return to the OR for a complication directly related to the original surgery.

04Can 25830 and a wrist arthrodesis code (e.g., 25800) be billed together on the same date?

Only if distinct, separately documented procedures were performed. NCCI edits apply across the wrist arthrodesis family. If billing both, modifier 59 (or XS for a distinct structure) is required and must be supported by documentation showing separate operative fields.

05Is 25830 performed in an ASC or HOPD setting?

Both are common sites of service. HOPD payment is substantially higher than ASC payment — see the Site of Service comparison table on this page. Payer contract terms and patient medical complexity typically determine site selection.

06What ICD-10 codes typically support 25830?

Common supporting diagnoses include DRUJ arthritis (post-traumatic or degenerative), rheumatoid arthritis affecting the wrist, chronic DRUJ instability, and malunion of the distal radius. The diagnosis must specifically implicate the DRUJ — a generic wrist pain code alone will not satisfy medical necessity review.

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 surgical approach, the measured length of ulnar segment resected, fixation construct at the DRUJ, bone graft type and harvest site, and intraoperative stability assessment directly from dictation. That prevents the most common audit flag for 25830 — an operative note that documents fusion but omits the segmental resection detail, which auditors use to downcode or deny the claim.

See how Mira captures CPT 25830 documentation