Re-amputation of the hand at the transmetacarpal level — a secondary surgical revision following a prior transmetacarpal amputation.

Verified May 8, 2026 · 6 sources ↓

Medicare: $782.25
Total RVUs: 23.42
Global, days: 90
Region: Hand

Drawn from CMSEmednyAxogenincMdclarityAAPC

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative note must explicitly state this is a re-amputation, not secondary wound closure or scar revision (25929 describes those separately)
Document the level of re-amputation and the specific transmetacarpal ray(s) involved
State the clinical indication — complication, residual limb breakdown, prosthetic fitting failure — with supporting pre-op findings
Identify whether this re-amputation is staged/planned (modifier 58) or unplanned return for a related complication (modifier 78)
If modifier 22 is appended, the operative note must quantify the additional work and time above the typical procedure
Record laterality (right or left hand) to support LT/RT modifier use

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 50 Bilateral procedure 51 Multiple procedures 58 Staged or related 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25931 describes a re-amputation performed at the transmetacarpal level, following a previous transmetacarpal amputation (25927). This is a distinct secondary procedure — not routine post-op wound care — indicated when the residual limb requires surgical revision to address complications, refine the stump, or optimize prosthetic fitting. It sits at the end of the 25900–25931 forearm and wrist amputation code family, specifically as the re-amputation following 25927 (transmetacarpal amputation).

The 90-day global period means all routine post-op care through day 90 is bundled. Any unrelated E/M or procedure billed within that window requires modifier 24 or 79, respectively. Because this is already a secondary procedure by definition, document clearly that it is a planned or staged re-amputation — not just wound management — to distinguish it from services that would be bundled under the original amputation's global period.

Site of service matters here. Medicare assigns 25931 a J1 status indicator in the HOPD setting, and it carries an ASC G2 status indicator, meaning ASC payment is based on the OPPS relative rate and is subject to the multiple-procedure discount. Confirm facility status before submitting, as HOPD and ASC payments differ materially (see the Site of Service comparison table).

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.84
Practice expense RVU	13.91
Malpractice RVU	1.67
Total RVU	23.42
Medicare national rate	$782.25
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	$782.25
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 25931 get rejected.

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

Procedure billed during the global period of the original amputation without an appropriate modifier (58, 78, or 79) to indicate its relationship to the prior surgery
25931 confused with 25929 (secondary closure or scar revision) — payers deny when the operative note describes wound revision rather than true re-amputation
Missing or insufficient documentation of medical necessity for the re-amputation, particularly when the indication is prosthetic optimization rather than acute complication
Site-of-service mismatch — claim submitted for ASC but documentation or facility type does not support outpatient setting eligibility

Frequently asked questions

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

01How is 25931 different from 25929?

25929 is secondary closure or scar revision after transmetacarpal amputation. 25931 is an actual re-amputation — bone is transected at a new level. If the operative note describes only wound closure or scar work, 25929 is the correct code. Billing 25931 when the documentation supports only revision is a common audit target.

02What modifier applies if 25931 is performed during the global period of the original amputation?

Use modifier 58 if this re-amputation was planned or staged as part of the treatment plan. Use modifier 78 if it's an unplanned return to the OR for a complication related to the original amputation. Modifier 79 applies only if the re-amputation is truly unrelated to the original procedure, which is rare in this context.

03Can 25931 be billed bilaterally?

Bilateral transmetacarpal re-amputation is clinically uncommon but not impossible. If performed on both hands, append modifier 50 and document bilateral involvement explicitly in the operative note. Use LT and RT on separate line items if payer policy requires split billing instead of modifier 50.

04Is 25931 payable in an ASC?

Yes, but with an important caveat. CMS assigns 25931 a G2 ASC status indicator, meaning payment is based on the OPPS relative rate and subject to the multiple-procedure discount. Earlier inpatient-only lists (pre-2026) included related amputation codes — confirm current ASC payability with your MAC before scheduling.

05When is modifier 22 justified for 25931?

Modifier 22 applies when the re-amputation requires substantially more work than typical — for example, extensive scarring from prior surgery, vascular compromise requiring intraoperative decision-making, or anatomic complexity from prior trauma. The operative note must document the specific factors that increased work and time. Without that detail, payers will deny the upward adjustment.

06Does the 90-day global period for 25931 start fresh after the re-amputation?

Yes. Once 25931 is performed and billed, a new 90-day global period begins for that procedure. Routine post-op visits, wound checks, and stitch removals within 90 days of the re-amputation are bundled. Services unrelated to the re-amputation in that window need modifier 24 (E/M) or 79 (surgical procedure).

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 re-amputation level, specific transmetacarpal ray(s) resected, clinical indication, and whether the procedure is staged or an unplanned return — pulling these directly from surgeon dictation. That prevents the most common denial: a note that reads like wound revision (25929) when the procedure is a true re-amputation (25931), or a missing global-period modifier that triggers automatic bundling with the original amputation.

See how Mira captures CPT 25931 documentation