Secondary closure or scar revision following disarticulation through the wrist joint.

Verified May 8, 2026 · 6 sources ↓

Medicare: $623.93
Work RVU: 7.46
Global, days: 90
Region: Wrist

Drawn from CMSEmednyCDCCgsmedicareCodingbooks

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative report must specify that this is a secondary procedure following prior wrist disarticulation — reference the index procedure date.
Describe the stump condition: open wound, dehiscence, hypertrophic scar, or scar adherence affecting prosthetic fitting.
Document the surgical technique: tissue debridement extent, flap design or advancement, closure layers, and any bone contouring performed.
Specify laterality (right or left wrist) explicitly in both the operative note and the procedure order.
If modifier 22 is appended, include a separate attestation documenting the factors — prior infection, complex scarring, multiple revision attempts — that increased operative time and complexity beyond standard.
If an assistant surgeon is billed, document medical necessity for assistance in the operative note.

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 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 XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25922 covers secondary closure or scar revision after a wrist disarticulation — it is the revision counterpart to 25920 (primary disarticulation through the wrist). This code applies when the original amputation wound requires additional surgical attention: formal closure of a previously open or incompletely closed stump, or revision of a problematic scar that impairs prosthetic fitting, causes pain, or creates wound-healing failure.

The 90-day global period means all routine post-operative care after the 25922 procedure itself is bundled. If the patient requires a re-amputation at a more proximal level during that global window, that is coded separately as 25924 with modifier 78 (unplanned return to the OR for a related procedure). Unrelated procedures during the global period require modifier 79. Laterality modifiers LT and RT are expected on every claim — wrist-level amputations are inherently unilateral, and missing laterality is a fast path to denial.

Site of service matters here: HOPD and ASC payment rates differ substantially (see the Site of Service comparison table). When billing for an assistant surgeon, use modifier 80 for an MD/DO or AS for a PA, NP, or CNS. Modifier 22 is available when the revision work is significantly more complex than typical — extensive scarring, adherent tendons, or prior infection — but requires contemporaneous documentation quantifying the additional time and complexity.

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 (7.46) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (18.68) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.46
Practice expense RVU	9.63
Malpractice RVU	1.59
Total RVU	18.68
Medicare national rate	$623.93
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	$623.93
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 25922 get rejected.

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

Missing laterality modifier (LT or RT) — payers expect it on every wrist-level amputation claim.
Billing 25922 without establishing a prior disarticulation procedure (25920) in the patient's history; payers may reject revision coding without a traceable index procedure.
Submitting 25922 during the global period of 25920 without a modifier — it bundles unless modifier 78 or 79 is applied with supporting documentation.
Modifier 22 added without an attached operative note explanation; payers routinely deny increased complexity claims lacking contemporaneous documentation.
Assistant surgeon claim (modifier 80 or AS) denied when the operative note does not support medical necessity for assistance on a revision procedure of this complexity.

Frequently asked questions

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

01What is the difference between 25920, 25922, and 25924?

25920 is the primary disarticulation through the wrist. 25922 is secondary closure or scar revision of that stump. 25924 is formal re-amputation at the wrist level. Use the code that matches what was actually performed — they are not interchangeable.

02Can 25922 be billed during the global period of 25920?

Yes, but not without a modifier. If the return to the OR for stump revision is related to the original disarticulation, append modifier 78. If it is unrelated, use modifier 79. Without a modifier, the claim bundles into the 25920 global and denies.

03Is a laterality modifier required on 25922?

Yes. Append LT or RT on every claim. Wrist disarticulations are inherently unilateral, and most payers will deny or suspend the claim without a laterality modifier present.

04When is modifier 22 appropriate for 25922?

When the revision is substantially more complex than typical — dense post-infection scarring, multiple prior failed closures, significant skin deficiency requiring flap work. The operative note must explicitly quantify what made it harder and estimate additional time. Attaching the note to the claim proactively reduces the likelihood of automatic denial.

05Can 25922 and 25924 be billed on the same date?

No. 25924 (re-amputation) is a more definitive procedure that inherently includes any wound revision performed at the same operative session. Bill only 25924 if re-amputation is performed; 25922 would be bundled.

06Does site of service affect reimbursement for 25922?

Yes, materially. HOPD and ASC payment rates differ — see the Site of Service comparison table on this page. Confirm your facility's contract rates against the Medicare fee schedule figures before scheduling the case at a given site.

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 stump condition prompting revision (open wound, dehiscence, scar adherence, prosthetic fitting failure), the surgical approach and closure technique, laterality, and whether a prior wrist disarticulation is referenced with its date. That documentation chain prevents the two most common 25922 denials: missing laterality and unsubstantiated revision coding when no index procedure is on file.

See how Mira captures CPT 25922 documentation