CPT code 25446: Wrist arthroplasty, distal radius and carpus2026 Medicare rate & RVUs in Maryland
Reports prosthetic wrist joint replacement involving both the distal radius and carpus, typically for advanced joint destruction requiring reconstruction of both sides.
CMS doesn’t publish an office rate for 25446 in Maryland.
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 25446 covers
This code represents prosthetic replacement of the wrist joint involving the distal radius and the carpal side of the joint. An orthopedic hand or wrist surgeon typically performs the operation in a surgical facility for advanced wrist joint destruction, such as severe degenerative or post-traumatic arthritis, when the operative plan replaces both areas.
Select this code when the operative report documents prosthetic replacement of the distal radius and carpus together; replacement limited to the distal radius, ulna, or an individual carpal bone is reported with a more specific code. Document the side, structures replaced, and prosthetic reconstruction, and distinguish an initial replacement from revision surgery. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeons require 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 25446 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | Unavailable | $1,114.42 |
| Rest of Maryland | Unavailable | $1,052.99 |
| Washington, DC area | Unavailable | $1,162.02 |
How the 25446 rate is calculated
Each of 25446’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 · 25446
RVUs × geographic indexes × conversion factor
Work16.87
16.87 RVUs× 1.000 GPCI
Practice expense11.34
11.34 RVUs× 1.000 GPCI
Malpractice3.28
3.28 RVUs× 1.000 GPCI
Adjusted RVUs
31.4900
Conversion factor
$33.4009
Medicare rate
$1,051.79
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 25446
25446 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 25446
Wrist arthroplasty, distal radius and carpus
| 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 · 25446
Wrist arthroplasty, distal radius and carpus
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
25446 without 50 · national facility
$1,051.79
Wrist arthroplasty, distal radius and carpus
25446-50 · Bilateral: 150%
$1,577.69
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).
25446 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 25441Wrist arthroplastyDistal radius prosthesis
- 25441 is limited to prosthetic replacement of the distal radius. Use 25446 when the operative reconstruction also replaces the carpus.
- 25442Ulna arthroplastyProsthetic distal ulna
- 25442 addresses prosthetic arthroplasty of the distal ulna. It does not describe replacement of the distal radius and carpus together.
- 25445Trapezium arthroplastyProsthetic replacement
- 25445 is for prosthetic arthroplasty of the trapezium, not a wrist joint replacement involving the distal radius and carpus.
- 25449Wrist revisionArthroplasty revision
- 25449 describes revision wrist arthroplasty. Choose it for revision surgery rather than an initial prosthetic replacement involving the distal radius and carpus.
25446 billing questions
When should this code be used instead of 25441?
Use 25446 when the prosthetic reconstruction replaces both the distal radius and carpus. Code 25441 describes prosthetic arthroplasty limited to the distal radius.
How does this differ from 25449?
25446 describes the replacement procedure involving the distal radius and carpus. Code 25449 is for revision wrist arthroplasty; use the code that matches whether the operation is an initial replacement or a revision.
What operative documentation supports 25446?
The operative report should identify the side, the distal radius and carpal structures replaced, and the prosthetic reconstruction performed.
How is bilateral surgery reported?
Report bilateral performance with modifier 50. CMS pays bilateral procedures at 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What postoperative care is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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
Show the CMS file lines behind this rate
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