CPT code 25690: Lunate reduction, closed, with manipulation2026 Medicare rate & RVUs in Missouri
Reports closed manipulative reduction of a dislocated lunate, rather than open treatment or treatment of a wrist fracture-dislocation.
CMS doesn’t publish an office rate for 25690 in Missouri.
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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On this page 9 sections
What 25690 covers
This service involves manipulating a dislocated lunate back into position without surgically exposing the joint. An orthopedic or hand surgeon may perform the reduction in an emergency department or surgical setting, often with anesthesia or sedation. The injury is a lunate dislocation, not simply a carpal fracture or a dislocation of the distal radioulnar joint.
Report the service when documentation supports a lunate dislocation and a closed reduction performed by manipulation. Record the affected wrist, reduction method, and relevant findings; distinguish an associated fracture-dislocation from an isolated lunate dislocation. The code has a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 identifies bilateral treatment and is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are 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 25690 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $465.78 |
| Metropolitan St. Louis, MO | Unavailable | $470.11 |
| Rest of Missouri | Unavailable | $445.96 |
How the 25690 rate is calculated
Each of 25690’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 · 25690
RVUs × geographic indexes × conversion factor
Work5.58
5.58 RVUs× 1.000 GPCI
Practice expense7.66
7.66 RVUs× 1.000 GPCI
Malpractice1.20
1.20 RVUs× 1.000 GPCI
Adjusted RVUs
14.4400
Conversion factor
$33.4009
Medicare rate
$482.31
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 25690
25690 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 25690
Lunate reduction, closed, with manipulation
| 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) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| 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 · 25690
Lunate reduction, closed, with manipulation
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
25690 without 50 · national facility
$482.31
Lunate reduction, closed, with manipulation
25690-50 · Bilateral: 150%
$723.47
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).
25690 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 25695Lunate dislocationOpen treatment
- Both address lunate dislocation, but 25690 is for closed manipulative reduction; 25695 is for open treatment.
- 25680Wrist fracture careTrans-scaphoid perilunate injury
- Use 25680 for a trans-scaphoid perilunar fracture treated closed with manipulation, not an isolated lunate dislocation.
- 25660Wrist dislocationRadiocarpal or intercarpal
- This code addresses a radiocarpal or intercarpal dislocation involving one or more bones; 25690 is specific to lunate dislocation.
25690 billing questions
When is this code used instead of open lunate treatment?
Use this code for a lunate dislocation reduced by closed manipulation. When the surgeon exposes the joint to treat the dislocation, consider 25695 instead.
Does this code describe treatment of a perilunate fracture-dislocation?
No. It describes closed manipulative reduction of a lunate dislocation. A trans-scaphoid perilunar fracture-dislocation is a different injury; code selection depends on the fracture pattern and treatment performed.
What documentation supports reporting the reduction?
Document the lunate dislocation, the affected wrist, and that the lunate was reduced by closed manipulation. Include relevant examination and imaging findings and the treatment performed.
Are related postoperative visits included?
Yes. The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
How are bilateral procedures and multiple procedures paid?
Modifier 50 identifies bilateral treatment and is paid at 150%. For multiple procedures in the same session, the highest-valued procedure is paid in full and the others are reduced to 50%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
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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