Revision surgery on the residual stump following transmetacarpal amputation, remodeling skin and muscle to correct improper initial closure, contracture pain, or to prepare the limb for prosthetic fitting.

Verified May 8, 2026 · 6 sources ↓

Medicare: $571.82
Work RVU: 7.62
Global, days: 90
Region: Hand

Drawn from CMSAAPCFindacodeMdclarityEmedny

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specific anatomical finding requiring revision — e.g., contracture, improper skin closure, adherent scar — not just 'stump revision'
Operative note detailing surgical steps: tissue layers addressed, extent of resection or remodeling, closure technique
Indication for return to OR and whether the revision was planned (staged) or unplanned (complication-driven)
Laterality documented — right or left hand — to support LT/RT modifier assignment
Prior amputation procedure details, including date, to establish relationship to any active global period
Prosthetic-fitting goal documented if that is the clinical driver for the revision

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 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25929 covers secondary surgical intervention on the stump created by a transmetacarpal amputation — the removal of fingers and a portion of the hand. The surgeon remodels the soft tissue envelope, which may involve revising scar tissue, releasing contractures, or reshaping the residual limb. The indication is typically failed primary closure, symptomatic scarring, or prosthetic-fitting requirements that weren't addressed at the time of the original amputation.

The code sits in the Amputation Procedures on the Forearm and Wrist section of the CPT manual. It carries a 90-day global period, so any routine post-op management from the revision surgery is bundled through day 90. If the original amputation was performed by a different surgeon or at a different encounter, modifier context matters — returning to the OR for a planned staged revision within the global period of the initial amputation requires modifier 58; an unplanned return for a related complication requires modifier 78.

Because this is a revision procedure, payers scrutinize whether the original amputation's global period is still active and whether the revision is distinct from expected post-op care. The operative note must clearly describe the stump pathology driving the return to the OR — generic language like 'stump revision for improved function' without specifying the anatomical problem and surgical steps is a common audit flag.

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 (7.62) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.12) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.62
Practice expense RVU	7.87
Malpractice RVU	1.63
Total RVU	17.12
Medicare national rate	$571.82
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	$571.82
HOPD (APC 5054) Hospital outpatient department	$2,107.97
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,128.57

Common denial reasons

The recurring reasons claims for CPT 25929 get rejected.

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

Procedure billed as a new surgery when payer treats it as bundled into the global period of the original amputation
Missing or incorrect modifier when billing within the 90-day global of a prior procedure — modifier 58 vs. 78 confusion is a top trigger
Operative note too vague to justify a separate surgical encounter — 'stump cleanup' language without anatomical specificity
Laterality mismatch between claim and operative report when LT or RT modifier is applied
ICD-10 diagnosis code does not clearly reflect a complication or condition distinct from expected post-amputation healing

Frequently asked questions

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

01Is 25929 billable during the global period of the original transmetacarpal amputation?

Yes, but modifier selection is critical. Use modifier 58 if the revision was planned or staged at the time of the original amputation. Use modifier 78 if the patient made an unplanned return to the OR for a complication related to the amputation. Without one of these modifiers, the claim will deny as bundled into the original global period.

02What modifier do I use when 25929 is performed on both hands at the same session?

Bill with modifier 50 for a bilateral procedure reported on a single line, or with LT and RT on separate lines depending on payer preference. Confirm your payer's bilateral billing convention before submitting — Medicare generally accepts modifier 50 on a single line.

03Can I bill an E/M visit on the same day as 25929?

Only if the visit is for a separately identifiable reason unrelated to the decision to perform the stump revision. Append modifier 25 to the E/M. If the visit was solely to decide to perform the surgery, it is bundled.

04What ICD-10 codes pair with 25929?

Common pairings include codes for late complications of amputation stumps (e.g., T87.2x series for necrosis or infection of upper limb amputation stump) and Z89 status codes for acquired absence. The diagnosis must reflect the clinical reason for revision, not just the original amputation history.

05Does 25929 have a 90-day global period of its own?

Yes. Once 25929 is performed, its own 90-day global period begins. Routine post-op visits, dressing changes, and suture removal through day 90 are bundled. Unrelated problems during that window need modifier 79; complications requiring a return to the OR need modifier 78.

06When is modifier 22 appropriate for 25929?

When the revision is substantially more complex than typical — for example, extensive soft tissue contracture requiring multilayer reconstruction or unusually prolonged operative time. Document total operative time and the specific factors that increased complexity. Without that documentation, modifier 22 will be denied or ignored.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the specific stump pathology from dictation — contracture location, scar characteristics, failed closure findings — along with the surgeon's description of each tissue layer addressed and the closure method used. It also flags whether the surgeon characterizes the case as staged or unplanned, prompting the correct modifier (58 vs. 78) before the claim is submitted. This prevents the most common denial pattern for 25929: an operative note that reads like routine post-op care rather than a distinct surgical intervention.

See how Mira captures CPT 25929 documentation