Krukenberg procedure: surgical separation of the radius and ulna in a forearm amputation stump to create a functional pincer grasp powered by the pronator teres muscle.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,059.48
Total RVUs: 31.72
Global, days: 90
Region: Wrist

Drawn from CMSAAPCAAOSEmednyNIH

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm prior amputation status and stump condition in the operative note
Name the procedure explicitly as 'Krukenberg procedure' — do not use generic amputation revision language
Document the surgical separation technique for the radius and ulna, including approach and extent of dissection
Document pronator teres muscle status and its role in the reconstructed pincer mechanism
Include pre-op indication: sensate stump, patient candidacy, and expected functional gain
If bilateral, document each limb separately with distinct clinical justification

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 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25915 describes the Krukenberg procedure, a specialized reconstructive amputation surgery performed on a previously amputated forearm. The surgeon separates the radius and ulna, reshaping the stump into two functional prongs that act as a biological pincer. The pronator teres muscle drives active opposition between the two bony segments, giving the patient a sensate, self-powered grasp without a prosthetic device.

This is a distinct reconstructive step — not the initial amputation — and is coded separately from primary forearm amputation (25900) or re-amputation (25909). It carries a 90-day global period under CMS, meaning all routine post-op management through day 90 is bundled. Any unrelated E/M or procedure during that window requires modifier 24 or 79, respectively.

Bilateral performance is anatomically possible but clinically rare; if billed bilaterally, append modifier 50 and bill as a single line. Operative notes must name the specific technique and document pronator teres function or integrity — vague descriptions of 'forearm amputation revision' are a common audit trigger for this code.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	17.08
Practice expense RVU	11.01
Malpractice RVU	3.63
Total RVU	31.72
Medicare national rate	$1,059.48
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	$1,059.48
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 25915 get rejected.

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

Operative note uses generic 'forearm amputation revision' language without naming the Krukenberg procedure or describing the radial-ulnar separation
Payer treats 25915 as bundled with a same-day amputation code (25900/25909) without a distinct session or modifier
Missing documentation of pronator teres integrity, leading auditors to question whether the functional reconstruction was actually performed
Global period conflict: post-op visit billed without modifier 24 when prior surgery's 90-day window is still active
ICD-10 mismatch — using a traumatic amputation code instead of an acquired absence code (Z89.2xx) for a reconstructive procedure on a healed stump

Frequently asked questions

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

01How does 25915 differ from 25900 or 25909?

25900 is the primary forearm amputation; 25909 is re-amputation of that stump. 25915 is the Krukenberg procedure — a distinct reconstructive surgery that splits the existing stump into a functional pincer. It is not a repeat amputation and should not be coded as one.

02Can 25915 be billed the same day as 25900?

Only in rare circumstances where the Krukenberg reconstruction is performed in the same operative session as the initial amputation. If so, append modifier 51 to the secondary code and ensure the operative note documents both as discrete, separately performed procedures with distinct steps.

03What ICD-10 code supports 25915?

Use an acquired absence of limb code (Z89.2xx series) for a patient with a healed prior amputation undergoing Krukenberg reconstruction. Traumatic amputation codes apply only if this is an acute-setting procedure on a fresh amputation injury, which is uncommon for this technique.

04Does the 90-day global period apply, and what does it cover?

Yes. 25915 carries a 90-day global period. That includes the day-before visit, the surgery itself, and all routine post-op care through day 90 — dressing changes, suture removal, occupational therapy coordination visits billed by the operating surgeon. Anything unrelated needs modifier 24 (E/M) or 79 (unrelated procedure).

05When is modifier 22 appropriate for 25915?

Modifier 22 applies when the work is substantially greater than typical — for example, a scarred or previously irradiated stump requiring extensive dissection to safely separate the radius and ulna. Document total operative time, the specific complexity encountered, and why it exceeded standard effort. Without that, payers will strip the modifier.

06Is 25915 ever performed bilaterally, and how is it billed?

Bilateral Krukenberg is performed, particularly in bilateral upper-extremity amputees. Bill with modifier 50 as a single line. Reimbursement is typically capped at 150% of the single-procedure fee schedule amount. Document each limb's operative findings separately in the note.

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 Krukenberg technique by name from dictation, flags the radius-ulna separation method, and documents pronator teres muscle status in the operative note. This prevents the most common denial trigger for 25915: audit teams flagging notes that describe only generic 'forearm revision' without the specific reconstructive steps that distinguish this code from 25909.

See how Mira captures CPT 25915 documentation