CPT code 25431: Carpal bone repair, nonunion, excluding scaphoid2026 Medicare rate & RVUs in Texas
Repair a nonunion in a carpal bone other than the scaphoid, with or without internal fixation, when operative treatment is performed.
CMS doesn’t publish an office rate for 25431 in Texas.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 25431 covers
This code describes operative repair of a carpal bone that has failed to unite, excluding the scaphoid. The surgeon addresses the persistent nonunion and may use internal fixation; the code covers repair whether or not fixation is used. It is distinct from treatment directed at a scaphoid nonunion and from procedures on the radius or ulna. These operations are generally performed by orthopedic or hand surgeons in a surgical setting.
Report the code when the operative target is a nonunion of a non-scaphoid carpal bone. The operative report should identify the bone and document the nonunion and the repair performed, including fixation when used. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care through day 90. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. For bilateral repair, modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 25431 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | $748.83 |
| Beaumont, TX | Unavailable | $705.69 |
| Brazoria, TX | Unavailable | $722.28 |
| Dallas, TX | Unavailable | $730.07 |
| Fort Worth, TX | Unavailable | $727.96 |
| Galveston, TX | Unavailable | $726.52 |
| Houston, TX | Unavailable | $767.89 |
| Rest of Texas | Unavailable | $715.77 |
How the 25431 rate is calculated
Each of 25431’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 25431
RVUs × geographic indexes × conversion factor
Work10.62
10.62 RVUs× 1.000 GPCI
Practice expense9.24
9.24 RVUs× 1.000 GPCI
Malpractice2.26
2.26 RVUs× 1.000 GPCI
Adjusted RVUs
22.1200
Conversion factor
$33.4009
Medicare rate
$738.83
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 25431
25431 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 25431
Carpal bone repair, nonunion, excluding scaphoid
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 25431
Carpal bone repair, nonunion, excluding scaphoid
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
25431 without 50 · national facility
$738.83
Carpal bone repair, nonunion, excluding scaphoid
25431-50 · Bilateral: 150%
$1,108.25
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
25431 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 25440Scaphoid repairNonunion repair
- Use 25431 for a nonunion in a carpal bone other than the scaphoid. Use 25440 when the nonunion is in the scaphoid.
- 25430Carpal bone graftVascularized graft
- Code 25430 describes placement of a vascularized pedicle graft into a carpal bone. Code 25431 describes repair of a non-scaphoid carpal bone nonunion.
- 25405Forearm bone repairOne bone, autograft
- Code 25405 addresses repair with grafting for a radius or ulna nonunion. Code 25431 applies to a non-scaphoid carpal bone.
25431 billing questions
How is this code distinguished from 25440?
This code is for a nonunion of a carpal bone other than the scaphoid. Code 25440 is the corresponding repair code when the nonunion involves the scaphoid.
Does the code include internal fixation?
The repair is reported with or without internal fixation. The operative note should describe the nonunion repair and identify fixation if it was used.
Can this be reported with another procedure performed in the same session?
When multiple procedures are performed in the same session, Medicare pays the highest-valued procedure in full and applies the standard 50% reduction to the others.
How is bilateral repair reported?
For bilateral repair, report modifier 50; the CMS payment rule for this code is 150%.
May an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
What documentation supports reporting this code?
Document the affected carpal bone, its nonunion, and the operative repair performed. Make clear that the treated bone is not the scaphoid.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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