Surgical amputation performed across the metacarpal bones, removing all fingers and the distal portion of the hand at the transmetacarpal level.

Verified May 8, 2026 · 7 sources ↓

Medicare: $840.03
Total RVUs: 25.15
Global, days: 90
Region: Hand

Drawn from CMSFindacodeFastrvuAAPCEmedny

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify the exact level of bone transection through the metacarpals (e.g., proximal, mid, or distal metacarpal shaft) in the operative note.
Document the indication: traumatic injury, malignancy, infection, vascular compromise, or other condition requiring amputation.
Record which hand (left, right, or bilateral) with laterality reflected in the ICD-10-CM diagnosis code.
Describe the type of closure performed — primary closure vs. open/guillotine — because secondary closure is separately reportable under 25929.
Include intraoperative findings and confirmation that the procedure was performed at the transmetacarpal level, not through a joint (disarticulation) or more proximal.
Document medical necessity with pre-operative workup, imaging, or prior treatment attempts where applicable for non-traumatic indications.

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 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 25927 describes a transmetacarpal amputation — surgical removal of the fingers and distal hand by transecting through the metacarpal bones. This is a distinct level from wrist disarticulation (25920) and from digital amputations coded under the hand/finger section. The operative site is within the metacarpal shaft, not at a joint, which differentiates it anatomically and codewise from disarticulation procedures.

This code carries a 90-day global period. That means all routine post-op care, dressing changes, suture removal, and related visits from the day before surgery through day 90 are bundled. Anything unrelated to the amputation in that window requires modifier 24 on an E/M or modifier 79 on an unrelated procedure. A planned return for secondary closure or scar revision is coded separately as 25929; an unplanned return for a related complication uses modifier 78.

CMS has historically assigned this code an inpatient-only status indicator under HOPD rules. Verify current status before scheduling in an outpatient facility — billing 25927 in a non-approved setting triggers an automatic denial. When bilateral amputation is performed (rare but possible in polytrauma), append modifier 50 and bill on a single line.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.86
Practice expense RVU	14.39
Malpractice RVU	1.9
Total RVU	25.15
Medicare national rate	$840.03
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	$840.03
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 25927 get rejected.

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

Site-of-service mismatch: billing 25927 in an outpatient hospital setting when CMS inpatient-only status applies triggers automatic denial.
Laterality missing or mismatched between the procedure code modifier (LT/RT) and the ICD-10-CM diagnosis code.
Global period conflict: post-op visits billed without modifier 24 or 79 within the 90-day global window are bundled and denied.
Insufficient documentation of amputation level — operative notes that do not confirm transmetacarpal bone transection may cause downcoding or denial.
Billing 25927 when the procedure was actually a wrist disarticulation (25920) or a single-digit amputation, resulting in code mismatch with the operative report.

Frequently asked questions

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

01What is the difference between CPT 25927 and 25920?

25920 is a disarticulation through the wrist joint. 25927 is a transmetacarpal amputation — bone is cut through the metacarpal shafts, distal to the wrist. Different anatomical level, different code, different RVU weight.

02Can 25927 be billed in an outpatient hospital or ASC?

CMS has assigned 25927 inpatient-only status under HOPD rules in prior years. Confirm the current status indicator before scheduling — billing this in a non-approved outpatient setting results in automatic denial. Check the current OPPS Addendum B.

03If secondary closure is needed after a transmetacarpal amputation, is that included in 25927?

No. Secondary closure or scar revision is reported separately as 25929. If it's a planned staged procedure, use modifier 58 on 25929. If it's an unplanned return for a related complication, use modifier 78.

04What modifier applies when two surgeons each perform distinct portions of this amputation?

Modifier 62 applies when two surgeons function as co-primary surgeons performing distinct parts of the procedure. Both surgeons submit 25927 with modifier 62, and each documents their specific role in the operative note.

05How do I bill a post-op visit during the 90-day global for a condition unrelated to the amputation?

Append modifier 24 to the E/M code. The diagnosis code for that visit must clearly reflect the unrelated condition. Using the amputation ICD-10 code on the same visit will trigger a bundling denial.

06Is modifier 50 appropriate if both hands are amputated at the transmetacarpal level in the same session?

Yes. Bilateral transmetacarpal amputation in a single operative session is reported with 25927 and modifier 50 on one claim line. This is rare — typically polytrauma — and will require strong medical necessity documentation.

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 exact level of metacarpal transection, laterality, closure technique (primary vs. open), and the clinical indication from dictation. It flags if the operative note lacks explicit language confirming the transmetacarpal level — the most common trigger for audit scrutiny and level-of-service disputes. It also prompts the surgeon to specify whether secondary closure is anticipated, so 25929 can be planned and pre-authorized rather than retroactively justified.

See how Mira captures CPT 25927 documentation