Amputation of the hand performed as a disarticulation through the wrist joint.

Verified May 8, 2026 · 7 sources ↓

Medicare: $697.41
Work RVU: 8.8
Global, days: 90
Region: Hand

Drawn from CMSAMANovitasEmedny

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Explicit documentation of disarticulation at the wrist joint level, not just 'hand amputation' or 'wrist-level amputation'
Indication for amputation — trauma, infection, malignancy, vascular compromise, or other — with supporting clinical findings
Description of soft-tissue management, flap creation, and closure technique used
Laterality documented (right or left hand) to support LT or RT modifier if required by payer
Post-operative plan for residual limb management and anticipated prosthetic referral if applicable
Informed consent and pre-operative assessment noting the decision for amputation at this specific level

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 25 Significant separate E/M 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 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 7 cited references ↓

CPT 25920 describes surgical amputation of the hand accomplished by disarticulating through the wrist joint. The procedure involves careful soft-tissue management, bone-end preparation, and closure to create a functional residual limb. It carries a 90-day global period, meaning all routine post-operative care through day 90 is bundled — including wound checks, dressing changes, and suture removal.

This code is distinct from transmetacarpal amputation (25927) and from re-amputation or secondary closure codes (25922, 25924). If the operative note doesn't clearly describe disarticulation at the wrist joint level — as opposed to a more distal or proximal level — payers will question the code selection. Document the precise anatomic level explicitly.

For trauma-driven amputations, the indication, mechanism, and extent of tissue loss should be in the operative note. If operative complexity significantly exceeded what the code typically entails — severe contamination, vascular reconstruction, or unusually prolonged closure — modifier 22 with a supporting operative note narrative is appropriate. Bilateral wrist disarticulations on the same date are rare but would require modifier 50.

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 (8.8) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (20.88) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.8
Practice expense RVU	10.21
Malpractice RVU	1.87
Total RVU	20.88
Medicare national rate	$697.41
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	$697.41
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI G2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 25920 get rejected.

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

Operative note describes 'wrist amputation' without confirming disarticulation through the wrist joint, triggering a code-level dispute
Missing laterality documentation when payer requires LT or RT modifier on unilateral extremity procedures
E/M billed same-day without modifier 25, causing bundling denial when a pre-operative assessment was separately identifiable
Related procedure billed during the 90-day global period without modifier 78 or 79, resulting in automatic denial
Modifier 22 appended without an accompanying operative note narrative explaining the specific factors that increased physician work

Frequently asked questions

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

01What separates 25920 from 25927 (transmetacarpal amputation)?

25920 is a disarticulation through the wrist joint itself. 25927 is an amputation through the metacarpal bones, distal to the wrist. The operative note must state which anatomic level was used — auditors will not infer it.

02Can I bill a separate E/M on the same day as 25920?

Only if the E/M was a significantly and separately identifiable service beyond the pre-operative assessment bundled into the global. Append modifier 25 to the E/M and document the distinct medical decision-making. If the visit was the decision to operate, use modifier 57 instead.

03What modifier applies if I need to return to the OR during the 90-day global for a related complication?

Modifier 78 covers an unplanned return to the OR for a complication related to the original procedure within the global period. Use modifier 79 only if the return procedure is entirely unrelated to the original amputation.

04Is modifier 50 appropriate for bilateral wrist disarticulations?

Yes. If both hands are amputated at the wrist in the same operative session, report 25920 with modifier 50. Bill as a single line per most MAC requirements; reimbursement is capped at 150% of the single-procedure rate.

05When is modifier 22 justified for 25920?

When operative complexity materially exceeded typical work — for example, severe crush injury with extensive contamination, prolonged vascular management, or atypical anatomy from prior surgery. The operative note must narrate the specific factors; modifier 22 appended without that narrative will be denied or ignored.

06Are secondary closure or re-amputation billed under 25920?

No. Secondary closure or scar revision following wrist disarticulation uses 25922. Re-amputation after a prior wrist disarticulation uses 25924. These are separate codes and should not be reported with 25920 for the same episode.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the disarticulation level (wrist joint), the surgical indication, approach, flap design, bone preparation, and closure technique directly from dictation. It flags if the note says 'wrist-level amputation' without confirming joint disarticulation — the distinction that separates 25920 from adjacent codes and prevents level-of-service denials at audit.

See how Mira captures CPT 25920 documentation