Arthroscopic partial synovectomy of the wrist joint, removing inflamed synovial tissue to reduce pain and restore motion.

Verified May 8, 2026 · 5 sources ↓

Medicare: $470.95
Total RVUs: 14.1
Global, days: 90
Region: Wrist

Drawn from CMSAAPCNIHMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify which wrist compartments were entered (radiocarpal, midcarpal, distal radioulnar joint) and the extent of synovial involvement in each.
Describe the appearance and distribution of synovial pathology — hypertrophy, inflammation, fibrosis — to support medical necessity.
Identify all portals used and any additional findings encountered during the procedure, including the status of cartilage and ligaments.
Confirm the procedure as partial synovectomy; distinguish from complete synovectomy or debridement to support accurate code selection.
Document laterality explicitly (right vs. left wrist) to support LT/RT modifiers and prevent same-day bilateral billing issues.
Record preoperative conservative treatment failures (e.g., injections, splinting, therapy) to substantiate surgical necessity.

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 59 Distinct service 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 5 cited references ↓

CPT 29844 covers a surgical wrist arthroscopy in which the surgeon excises a portion of the synovial membrane lining the joint. The target is hypertrophic or inflamed synovium — tissue that, when proliferating abnormally, causes pain, swelling, and restricted motion. The surgeon introduces the arthroscope and resection instruments through small portals, visualizes the radiocarpal and/or midcarpal compartments, and removes the offending synovial tissue while preserving the joint capsule and surrounding structures.

This is a partial synovectomy, not a complete one — document exactly which compartments were debrided and how much tissue was removed. That distinction matters for NCCI bundling: 29844 is a column-two code to 29846 (wrist arthroscopy with excision of triangular fibrocartilage or joint debridement), meaning if both are performed ipsilaterally, 29844 is bundled into 29846 unless documentation supports distinct procedural service with a modifier.

The 90-day global period applies. All routine follow-up, portal dressing changes, and suture removal through day 90 are included. An unrelated procedure in that window requires modifier 79; a return to the OR for a related complication requires 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	6.35
Practice expense RVU	6.5
Malpractice RVU	1.25
Total RVU	14.1
Medicare national rate	$470.95
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	$470.95
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 29844 get rejected.

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

Bundling denial when 29844 is billed alongside 29846 on the same wrist without a modifier supporting distinct procedural service.
Medical necessity denial when the operative note lacks documentation of failed conservative treatment or does not describe the extent of synovial pathology.
Mutually exclusive denial when 29844 is billed same-day with open synovectomy codes (e.g., 25116) — some payers flag these as overlapping services.
Missing or incorrect laterality modifier when bilateral wrist procedures are billed, causing claim-level rejection or overpayment audit flags.
Global period denial for post-op visits billed without modifier 24 when they are routine follow-up within the 90-day window.

Frequently asked questions

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

01Is 29844 always bundled into 29846 when both are performed on the same wrist?

Per NCCI, 29844 is a column-two code to 29846, so it is bundled by default. A modifier (typically 59) can bypass the edit if documentation supports that the synovectomy was a distinct procedure from the debridement or TFCC work performed under 29846 — but the operative note must make that case clearly.

02Can 29844 be billed with open wrist synovectomy (25116) on the same date?

Some payers, including Aetna, flag 29844 and 25116 as mutually exclusive when billed same-day, particularly alongside 25320. If the arthroscopic and open procedures were genuinely distinct, document the separate indications and surgical sites thoroughly before appending a modifier — expect scrutiny.

03What modifier covers the second wrist when bilateral wrist synovectomy is performed?

Bill the primary wrist with LT or RT and add modifier 50 if both wrists are addressed in the same session, or bill two lines with LT on one and RT on the other, per payer preference. Verify bilateral coverage with each payer before billing — many require prior authorization for bilateral arthroscopic procedures.

04Does fluoroscopy used during the arthroscopy bill separately?

No. Per CMS NCCI policy, fluoroscopy performed during any arthroscopic procedure is integral to the procedure and cannot be separately reported.

05If the arthroscopy is converted to an open procedure intraoperatively, what gets billed?

Bill only the open procedure code. Per NCCI Chapter 4 policy, neither a surgical arthroscopy code nor a diagnostic arthroscopy code may be reported alongside the open procedure when the conversion occurs intraoperatively.

06What ICD-10 diagnoses most commonly support 29844?

Rheumatoid arthritis of the wrist (M05.631–M05.632), synovitis and tenosynovitis of the wrist (M65.831–M65.832), and post-traumatic synovitis are the most common supporting diagnoses. The diagnosis must tie directly to the synovial pathology described in the operative note.

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 compartments entered, extent and distribution of synovial resection, portal placement, and intraoperative findings (cartilage condition, ligament integrity) directly from the surgeon's dictation. That specificity closes the gap between 'wrist arthroscopy performed' and documentation that survives a medical necessity audit or NCCI modifier challenge — particularly when 29844 and 29846 appear on the same claim.

See how Mira captures CPT 29844 documentation