Reoperation or secondary surgical procedure performed on a previously amputated forearm through the radius and ulna, addressing complications or revising the residual limb.

Verified May 8, 2026 · 5 sources ↓

Medicare: $645.97
Work RVU: 9.08
Global, days: 90
Region: Hand

Drawn from CMSAxogenincMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify that this is a secondary/reoperation procedure, not the index amputation
Document the indication for return to OR (e.g., wound dehiscence, bone prominence, flap necrosis, neuroma)
Identify laterality (right or left forearm) explicitly in the operative note
State the anatomic level through both the radius and ulna to distinguish from more proximal or distal procedures
If within 90-day global of a prior amputation, document whether the return was planned (staged) or unplanned (complication-related)
Record the surgeon of record for the original amputation to support correct modifier selection

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 58 Staged or related 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 25909 covers secondary surgical intervention at a forearm amputation site — through both the radius and ulna — performed after the initial amputation has already occurred. This includes procedures such as residual limb revision, bone shortening, skin flap revision, or management of surgical complications arising from the primary amputation. It is distinct from 25900 (primary amputation) and 25905 (open circular/guillotine technique), which represent the index procedures.

The 90-day global period is the most operationally significant billing factor for this code. Any surgeon who performed the original forearm amputation and bills 25909 within 90 days of that procedure must append modifier 78 if the return to the OR was unplanned and related to the original surgery. If the secondary procedure was planned and staged at the time of the primary, modifier 58 applies instead. Using the wrong modifier — or omitting one entirely — is the fastest path to a global-period denial.

Site of service matters significantly here. Medicare covers 25909 in the HOPD setting; the ASC payment listed by CMS for 2024 data showed this code was not covered by Medicare in the ASC. Confirm ASC eligibility with payer-specific contracts before scheduling. Laterality modifiers LT and RT are routinely expected and should match operative documentation precisely.

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 (9.08) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (19.34) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	9.08
Practice expense RVU	8.33
Malpractice RVU	1.93
Total RVU	19.34
Medicare national rate	$645.97
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	$645.97
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 25909 get rejected.

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

Missing or incorrect modifier during the 90-day global period of the primary amputation — modifier 78 required for unplanned related return, 58 for staged
Laterality modifier (LT or RT) absent or inconsistent with the operative report
Billed to ASC when Medicare does not cover 25909 in the ambulatory surgery center setting
Claim submitted without sufficient documentation distinguishing this as a secondary procedure rather than rebilling the primary amputation
Procedure coded at a different anatomic level than documented (e.g., disarticulation vs. through-bone amputation)

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What is the difference between CPT 25900 and 25909?

25900 is the primary forearm amputation through the radius and ulna. 25909 is the secondary or follow-up surgical procedure at that same site — use it when the patient returns to the OR after the initial amputation for revision, complication management, or residual limb refinement.

02Which modifier do I use if the patient returns to the OR within the 90-day global for a wound complication?

Modifier 78 — unplanned return to the OR for a procedure related to the original surgery. Do not use modifier 79 (unrelated procedure) or modifier 58 (planned/staged) for an unplanned complication-driven return.

03Is 25909 covered by Medicare in the ASC?

Based on 2024 CMS ASC payment data, 25909 was not covered by Medicare in the ASC setting. Confirm current ASC eligibility before scheduling; HOPD is the supported site of service under Medicare.

04Do I need laterality modifiers for 25909?

Yes. Append LT or RT to match the operative documentation. Payers routinely require laterality on extremity amputation codes, and a missing modifier is a straightforward denial trigger.

05Can a different surgeon bill 25909 during the original surgeon's global period?

Yes, with modifier 79 if the procedure is unrelated, or modifier 78 if it is related and the second surgeon performed the procedure. When a different surgeon operates during another provider's global, documentation must establish the medical necessity and the separate provider relationship — coordinate with the original surgeon's office to avoid duplicate billing conflicts.

06What ICD-10 diagnoses typically support 25909?

Common supporting diagnoses include residual limb complications such as wound dehiscence, bone prominence causing skin breakdown, post-amputation neuroma, or infection of the amputation site. The diagnosis must reflect the reason for the secondary surgery, not simply repeat the original amputation indication.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the operative indication (wound failure, bone prominence, neuroma, flap revision), confirms the anatomic level through radius and ulna, records laterality, and flags whether the procedure is staged or an unplanned return — the exact facts needed to choose between modifier 58 and 78. That distinction prevents automatic global-period denials without a manual appeal.

See how Mira captures CPT 25909 documentation