Re-amputation at the wrist/hand level following a prior disarticulation through the wrist joint, performed to revise or clean up a prior amputation stump.

Verified May 8, 2026 · 5 sources ↓

Medicare: $681.71
Total RVUs: 20.41
Global, days: 90
Region: Wrist

Drawn from CMSEmednyAAOS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Operative note must identify this as a re-amputation, not the initial wrist disarticulation, with explicit reference to the prior procedure
Document the indication: stump necrosis, infection, non-healing wound, or functional revision — generic 'stump revision' language invites medical necessity denials
Specify the level of bone resection and soft tissue management performed during the revision
Note whether the case was planned (staged) or unplanned (complication-driven) — this determines modifier 78 vs. 58
Include anesthesia type and facility setting to support site-of-service billing
If performed within the global period of 25920, document the clinical trigger and relationship to the original procedure

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 25 Significant separate E/M 52 Reduced services 58 Staged or related 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 5 cited references ↓

CPT 25924 covers a re-amputation at the wrist level — specifically revision surgery performed after a prior disarticulation through the wrist (25920). This is not the initial amputation; it is a return procedure to revise a problematic stump, address tissue necrosis, manage infection, or achieve a more functional residual limb. The code sits in the forearm/wrist amputation family alongside 25920 (initial wrist disarticulation) and 25922 (secondary closure or scar revision after wrist disarticulation).

The 90-day global period means the original amputation surgeon's global already encompasses routine post-op care. If 25924 is performed during that global window, it triggers modifier 78 (unplanned return to the OR for a related procedure) — which reduces payment to the intraoperative component only and does not reset the global clock. If a different surgeon performs the re-amputation, modifier 79 is not applicable here since the procedure is related; the second surgeon should bill with modifier 78 and document the clinical relationship clearly.

Site-of-service matters for reimbursement. HOPD and ASC payment rates differ substantially — see the Site of Service comparison on this page. Most wrist-level re-amputations are performed in the OR under general or regional anesthesia; billing in an office setting would trigger a site-of-service mismatch flag. Documentation must establish medical necessity for the revision, distinguishing this from a staged planned revision (modifier 58) versus an unplanned complication-driven return (modifier 78).

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.59
Practice expense RVU	9.99
Malpractice RVU	1.83
Total RVU	20.41
Medicare national rate	$681.71
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	$681.71
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 25924 get rejected.

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

Modifier 78 omitted when procedure is performed during the global period of the initial amputation, causing automatic bundling denial
Medical necessity not established — operative note fails to document why closure or scar revision (25922) was insufficient and re-amputation was required
Incorrect modifier selection: modifier 58 used instead of 78 for an unplanned complication-driven return, or no modifier appended at all
Site-of-service mismatch between the place of service billed and the facility where the procedure was performed
Prior authorization not obtained when required by payer for revision amputation surgery

Frequently asked questions

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

01What is the difference between 25922 and 25924?

25922 is secondary closure or scar revision after wrist disarticulation — soft tissue work only. 25924 is a re-amputation, meaning bone is resected and the stump level is revised. Use 25924 when the revision goes beyond skin and scar to include osseous work or formal stump reshaping.

02Which modifier applies if 25924 is performed during the global period of the original amputation?

Modifier 78 — unplanned return to the OR for a related procedure during the global period. This pays the intraoperative component only and does not reset the 90-day global clock. Do not use modifier 58, which is reserved for planned staged procedures.

03Does billing 25924 reset the global period?

Only if billed with modifier 58 (planned staged procedure). With modifier 78 (unplanned, related), the global clock from the original procedure continues and does not reset. Confirm with your payer — some commercial payers treat this differently than Medicare.

04Can 25924 and 25920 be billed together on the same date of service?

No. 25924 is by definition a re-amputation following a prior wrist disarticulation — they are not performed at the same operative session. If you are seeing these together on a claim, that is a coding error.

05Is prior authorization typically required for 25924?

Many commercial payers and some Medicaid managed care plans require prior authorization for revision amputation procedures. Verify before scheduling — emergent or urgent cases should be authorized retrospectively per payer policy, with documentation of the acute indication.

06What ICD-10 diagnosis codes support medical necessity for 25924?

Common supporting diagnoses include stump complications (T87 series — stump infection, necrosis, neuroma), traumatic amputation sequelae, and wound dehiscence codes. The ICD-10 must reflect why revision rather than wound care alone was necessary.

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 clinical trigger for re-amputation (stump necrosis, wound failure, infection, functional revision), the level of bone resection, tissue management performed, and whether the return to OR was planned or unplanned. That distinction — staged vs. complication-driven — directly determines whether modifier 58 or 78 is appended, which is the single most common audit flag for this code family.

See how Mira captures CPT 25924 documentation