Surgical amputation of the forearm through both the radius and ulna, removing the distal portion of the upper extremity at the forearm level.

Verified May 8, 2026 · 6 sources ↓

Medicare: $670.02
Work RVU: 9.37
Global, days: 90
Region: Wrist

Drawn from CMSAAPCNIHFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Osteotomy level documented in centimeters relative to the elbow or wrist joint for both radius and ulna
Indication for amputation — trauma, malignancy, infection, or ischemia — with supporting clinical rationale
Nerve management technique named (e.g., traction neurectomy, TMR, RPNI) for each major nerve divided
Vascular ligation method and identification of vessels ligated or cauterized
Soft tissue flap design and closure technique with note confirming adequate residual limb padding
Laterality (left or right forearm) explicitly stated in the operative note and on the claim

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 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 59 Distinct service 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 6 cited references ↓

CPT 25900 covers transradial amputation — surgical removal of the forearm through both the radius and ulna. This is a major ablative procedure typically performed for trauma, malignancy, severe infection, or critical ischemia when limb salvage is not viable. The 90-day global period covers all routine postoperative management, wound care, and follow-up visits through day 90. Anything unrelated to the amputation billed within that window requires modifier 24 (unrelated E/M) or 79 (unrelated procedure).

Side laterality must be captured at the time of billing. Append LT or RT on every claim — payers routinely reject forearm amputation claims submitted without a side designator. If bilateral amputation occurs in the same operative session (rare but possible in polytrauma), bill with modifier 50. Document the level of amputation precisely in the operative note: the osteotomy level relative to the elbow and wrist, management of the radial and ulnar bone ends, soft tissue flap design, nerve handling (traction neurectomy vs. targeted muscle reinnervation), and vessel ligation. Audit reviewers flag notes that omit osteotomy level or describe only 'amputation performed as planned.'

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (9.37) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (20.06) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	9.37
Practice expense RVU	8.81
Malpractice RVU	1.88
Total RVU	20.06
Medicare national rate	$670.02
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	$670.02
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 25900 get rejected.

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

Missing laterality modifier LT or RT causes automatic claim rejection by most payers
Operative note lacks osteotomy level, triggering medical necessity or specificity denials on audit
Post-op E/M visits billed without modifier 24 denied as included in the 90-day global period
Modifier 22 billed for increased complexity without supporting documentation quantifying the additional work
Unrelated procedures performed during the global period submitted without modifier 79, triggering global surgery bundling denials

Frequently asked questions

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

01Does CPT 25900 have a global period, and what does it include?

Yes — 90-day global. It covers the surgery, the day-before pre-op visit, and all routine post-op care through day 90 including wound checks, dressing changes, and suture removal. Bill unrelated E/M services with modifier 24 and unrelated procedures with modifier 79.

02Is laterality required when billing 25900?

Yes. Append LT or RT on every claim. Most payers reject forearm amputation claims without a side designator, and Medicare crosswalk systems expect laterality for any unilateral extremity procedure.

03When should modifier 22 be used with 25900?

Append modifier 22 when the work is substantially greater than typical — for example, severe burn contracture, prior failed replant, or extensive debridement required before a clean level could be established. The operative note must quantify the added time and complexity; a generic statement of difficulty won't support the modifier on audit.

04How does modifier 78 differ from modifier 79 in the context of 25900's global period?

Modifier 78 is for an unplanned return to the OR for a procedure directly related to the amputation — for example, revision of the residual limb for wound breakdown. Modifier 79 is for a completely unrelated procedure performed by the same surgeon during the 90-day global window. Never invert these; incorrect modifier assignment is a common audit finding.

05Can 25900 and a nerve procedure code be billed together on the same date?

Targeted muscle reinnervation (TMR) or RPNI performed at the time of amputation may be separately reportable depending on payer policy and NCCI edits in effect at the time of service. Review the NCCI Chapter 4 musculoskeletal edits and confirm with your MAC before billing both codes without a modifier.

06What is the site-of-service difference for 25900?

HOPD and ASC payment rates differ materially — see the Site of Service comparison table on this page. The physician's professional fee is the same regardless of facility, but the facility component varies significantly between settings.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the osteotomy level (cm from joint), laterality, nerve handling technique, vascular ligation, and flap design directly from dictation. That prevents the most common audit flag on amputation claims — an operative note that confirms a procedure occurred but doesn't specify where or how, which reviewers treat as insufficient documentation for a 90-day global procedure.

See how Mira captures CPT 25900 documentation