Arthroscopic wrist surgery involving excision of the triangular fibrocartilage complex (TFCC) and/or joint debridement performed through small portal incisions.

Verified May 8, 2026 · 9 sources ↓

Medicare: $487.99
Total RVUs: 14.61
Global, days: 90
Region: Wrist

Drawn from CMSAAPCFindacodeEatonhandAAOS

Documentation requirements

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

Source · Editorial brief grounded in 9 cited references ↓

Operative note must name the specific pathology addressed — TFCC tear, joint debridement, or both — not just 'wrist arthroscopy'
Portal placement and wrist compartments entered (radiocarpal, midcarpal, DRUJ) must be documented
Extent of TFCC excision or debridement described with findings supporting medical necessity
If converting to open procedure, document the reason for conversion and report only the open code
Fluoroscopy use, if any, documented as integral — do not support a separate imaging claim
ICD-10 diagnosis must align with the structure treated (e.g., M67.331–M67.332 for TFCC tear, S63.8 for wrist ligament injury)

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 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 50 Bilateral procedure AS PA/NP/CNS assistant XS Separate structure

What this code covers

Source · Editorial summary grounded in 9 cited references ↓

29846 covers surgical wrist arthroscopy specifically for TFCC excision, joint debridement, or both. It sits one step above 29845 (synovectomy) and below 29847 (internal fixation) in the wrist arthroscopy family. The 90-day global period means all routine post-op wrist care through day 90 is bundled — new unrelated problems in that window need modifier 24 or 25 on the E/M, and a staged or unrelated surgical procedure needs modifier 79.

NCCI rules are strict here: arthroscopic debridement is not separately reportable with a surgical arthroscopy on the same joint at the same encounter (the knee and shoulder carve-outs don't apply to the wrist). So if debridement is integral to the TFCC excision, don't stack 29844. Per AAOS Code-X guidance echoed in AAPC forums, 29844 is included in 29846. Fluoroscopy during the arthroscopy is also bundled — bill no separate imaging code. If the arthroscopic procedure is converted to open, bill only the open code; do not report 29846 alongside it.

Common companion procedures include ulnar shortening osteotomy for ulnar abutment syndrome — code that separately with modifier 59 (or XS) when a distinct incision supports it. Ganglion cyst excision done arthroscopically at the same encounter is reported with 29999, not 25111, since no open counterpart maps cleanly to the arthroscopic technique.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.72
Practice expense RVU	6.6
Malpractice RVU	1.29
Total RVU	14.61
Medicare national rate	$487.99
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	$487.99
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 29846 get rejected.

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

29844 billed alongside 29846 for the same wrist encounter — 29844 is bundled per NCCI/AAOS Code-X
Separate fluoroscopy code billed during arthroscopy — imaging is integral and not separately payable
Open procedure code and 29846 both reported after intraoperative conversion — only the open code is billable
Insufficient documentation of TFCC pathology or debridement extent, triggering medical necessity denial
Post-op E/M within the 90-day global billed without modifier 24 or 25 when the visit is unrelated

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 9 cited references ↓

01Can I bill 29844 with 29846 when debridement is performed alongside TFCC excision?

No. Per NCCI policy and AAOS Code-X, 29844 is included in 29846 for the same wrist at the same encounter. Bill only 29846.

02What code do I use for arthroscopic ganglion cyst excision of the wrist done at the same time as 29846?

Use 29999 (unlisted arthroscopy) with 25111 as the open comparator code for valuation purposes. There is no dedicated arthroscopic wrist ganglion code.

03Can I separately bill fluoroscopy used during the wrist arthroscopy?

No. Per NCCI Chapter 4, fluoroscopy performed during any arthroscopic procedure is integral and cannot be billed separately.

04If I add an ulnar shortening osteotomy for ulnar abutment syndrome, how do I bill that?

Bill the osteotomy separately with modifier 59 (or XS) if a distinct incision supports it. Document the separate incision explicitly in the operative note.

05What happens to the global period if the patient needs a return to the OR for a related complication?

Bill the return procedure with modifier 78 — unplanned return to the OR for a procedure related to the original surgery within the 90-day global. Modifier 79 is for unrelated procedures only.

06If the arthroscopy is converted to an open TFCC repair intraoperatively, what do I bill?

Bill only the open procedure code. Per NCCI rules, you cannot report 29846 alongside the open code when the arthroscopic approach was abandoned mid-procedure.

07Which specialties most commonly bill 29846?

Orthopedic surgery and hand surgery account for the vast majority of 29846 claims per CMS Physician Utilization and Payment Data.

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 wrist compartments entered, the specific TFCC pathology identified and treated, the extent of debridement, and any additional procedures requiring separate incisions. That documentation prevents the two most common denials: NCCI bundling flags when debridement isn't distinguished from the index procedure, and medical necessity rejections when the operative note lacks explicit pathology findings.

See how Mira captures CPT 29846 documentation