Arthroscopic wrist surgery with internal fixation for fracture or instability — screws or other hardware placed through arthroscopic portals to stabilize carpal bones or correct chronic wrist instability.

Verified May 8, 2026 · 8 sources ↓

Medicare: $517.05
Total RVUs: 15.48
Global, days: 90
Region: Wrist

Drawn from CMSCgsmedicareNIHEatonhandEmedny

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Portal placement documented by name (e.g., 3-4, 4-5, radial midcarpal)
Fracture pattern or instability diagnosis with specific bones involved (e.g., scaphoid, scapholunate ligament)
Type and placement of fixation hardware (screw size, number, trajectory)
Arthroscopic findings described in detail — vague language like 'instability noted' is insufficient
Confirmation that the procedure remained arthroscopic (if converted to open, open code must be used instead)
ICD-10 diagnosis code consistent with fracture or instability, not just 'wrist pain'
Operative note must distinguish any additional procedures performed and their separate medical necessity if billed separately

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 51 Multiple procedures 58 Staged or related 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side 50 Bilateral procedure

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

29847 covers arthroscopic wrist surgery in which the surgeon reduces and internally fixes a fracture or addresses chronic instability through the arthroscope. Standard 3-4 and 4-5 portals provide access; fixation hardware (typically screws) is inserted under arthroscopic visualization. This is a surgical arthroscopy code — diagnostic findings documented during the same session are bundled and cannot be separately reported.

The code carries a 90-day global period. All routine post-op management, wound care, and follow-up visits through day 90 are included. Unrelated E/M services in that window require modifier 24; a significant, separately identifiable E/M on the day of surgery requires modifier 25 appended to the E/M code. Synovectomy performed during the same session is bundled per AAOS global service guidelines and cannot be billed separately.

If the arthroscopic procedure is converted to an open approach intraoperatively, bill only the open code — do not stack 29847 with the open fixation code. Fluoroscopy used during the arthroscopy is integral and not separately reportable. For bilateral wrist procedures (rare), physician claims use modifier 50 on a single line; ASC claims use LT and RT on separate lines.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.04
Practice expense RVU	6.95
Malpractice RVU	1.49
Total RVU	15.48
Medicare national rate	$517.05
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	$517.05
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 29847 get rejected.

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

Diagnosis code mismatch — non-specific wrist pain ICD-10 codes don't support a surgical fixation procedure
Unbundling of synovectomy or diagnostic arthroscopy billed separately on the same date
Fluoroscopy or imaging guidance billed in addition — these are integral to the arthroscopic procedure
Open fixation code billed alongside 29847 when case was converted intraoperatively
Missing or vague operative note documentation of instability type or fixation technique
Global period violation — post-op visits billed without modifier 24 within the 90-day window

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01Can I bill synovectomy (29844 or 29845) separately when performed during the same session as 29847?

No. Per AAOS global service guidelines, synovectomy is bundled into 29847. Billing it separately will trigger an NCCI denial.

02If I perform a diagnostic arthroscopy and then proceed to fixation in the same session, do I bill both 29840 and 29847?

No. Surgical arthroscopy includes the diagnostic component. Bill only 29847. Reporting 29840 separately is an NCCI bundling violation.

03The case converted to open fixation intraoperatively. Can I still bill 29847?

No. CMS NCCI policy is clear: when an arthroscopic procedure converts to open, bill only the open procedure code. Do not report 29847 alongside the open code.

04What modifier applies if I perform a second unrelated procedure on the same wrist during the global period?

Use modifier 79 to indicate the procedure is unrelated to the original surgery. Modifier 78 is reserved for unplanned returns to the OR for a related complication — do not invert these.

05Is fluoroscopy separately billable when used during 29847?

No. CMS NCCI policy states fluoroscopy is integral to arthroscopic procedures and cannot be reported separately.

06How do I bill 29847 for a bilateral procedure in a physician office versus an ASC?

Physician claims: append modifier 50 to a single line. ASC claims: bill two lines, one with modifier LT and one with modifier RT, each with one unit of service.

07What ICD-10 diagnoses support 29847?

Fracture codes for carpal bones (e.g., S62.001A for scaphoid) or instability codes (e.g., M25.331 for wrist instability) are appropriate. Non-specific wrist pain codes will not support this procedure and are a top denial driver.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures portal names, carpal bones involved, instability diagnosis, fixation hardware type and count, and confirmation of arthroscopic completion from dictation. This prevents the two most common denials for 29847: vague operative notes that auditors flag as insufficient to support surgical fixation, and missing specificity in the fracture or instability diagnosis that causes ICD-10 mismatches on claim submission.

See how Mira captures CPT 29847 documentation