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Billing code 25100: Wrist biopsyMedicare rate & RVUs

An open wrist arthrotomy to obtain intra-articular tissue for diagnostic evaluation when a surgeon needs a surgical specimen rather than joint fluid alone.

CMS RVU26DEffective Oct 1, 2026109 payment localities64 Medicare services in 2024

Medicare pays $347.04 for 25100 nationally in a facility.

Medicare rate · 25100

Wrist biopsy

Swap in your local Medicare rate.

Work RVUs
3.92
Total RVUs
10.39
Global days
090

National rate · 2026

$347.04

Facility setting, before claim adjustments.

See every locality for 25100 → · Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

On this page 10 sections
  1. Medicare rate
  2. What 25100 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 25100 covers

The surgeon opens the wrist joint and removes a tissue sample for diagnostic evaluation. The specimen may be synovium or other intra-articular tissue submitted for pathologic or microbiologic study when the cause of persistent synovitis, suspected infection, or another joint abnormality remains uncertain. Orthopedic and hand surgeons typically perform this procedure in a hospital operating room or ambulatory surgery center; it is an open surgical biopsy, not needle aspiration or arthroscopic sampling.

Report the code when the operative record supports an open joint approach and tissue was obtained for biopsy. Document the wrist, operative approach, sampled tissue, and diagnostic purpose. CMS 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 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 25100 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

25100 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$311.35
Alaska*Unavailable$412.13
ArizonaUnavailable$337.17
ArkansasUnavailable$306.91
AtlantaUnavailable$356.08
AustinUnavailable$355.01
BakersfieldUnavailable$356.61
Baltimore/Surr. CntysUnavailable$369.51
BeaumontUnavailable$328.12
BrazoriaUnavailable$340.22

25100 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
25100 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 25100 rate is calculated

Each of 25100’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 · 25100

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 3.92Practice expense 5.63Malpractice 0.84

10.3900 adjusted RVUs×$33.4009 conversion factor=$347.04

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 25100

25100 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 25100

Wrist biopsy

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 25100

Wrist biopsy

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

25100 without 50 · national facility

$347.04

Wrist biopsy

25100-50 · Bilateral: 150%

$520.56

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).

When to use modifier 50

25100 compared with similar codes

Compare codes

25100 vs 25101 vs 29840 vs 20605: national Medicare rates

Swap in your local Medicare rate.

  • 25100
    Wrist biopsy · 3.92 wRVU
    —
  • 25101
    Wrist arthrotomy · 4.71 wRVU
    —
  • 29840
    Wrist arthroscopy · 5.54 wRVU
    —
  • 20605
    Joint procedure · 0.66 wRVU
    $57.12

How to choose

25101Wrist arthrotomy
25100 identifies an open wrist-joint procedure to obtain a diagnostic tissue specimen. 25101 is used when the operative objective is exploration or treatment.
29840Wrist arthroscopy
29840 is a diagnostic arthroscopic wrist procedure, with or without synovial biopsy. Choose 25100 when the biopsy is performed through an open arthrotomy.
20605Joint procedure
20605 describes aspiration or injection of an intermediate joint such as the wrist. It involves joint fluid, not an open surgical tissue biopsy.

Codes related to 25100

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 25100
CodeHow it relatesNational office range
Same family
25101Wrist arthrotomyRelated open wrist-joint procedure; used for exploration or treatment rather than a biopsy-focused service.No office rate
Used instead
25105Wrist synovectomyWrist synovium removal is a therapeutic procedure, unlike obtaining tissue primarily for diagnosis.No office rate
29840Wrist arthroscopyDiagnostic wrist arthroscopy can include synovial biopsy through an arthroscopic rather than open approach.No office rate

25100 billing questions

When is this code more appropriate than 25101?

Use 25100 when the surgeon opens the wrist joint to obtain tissue for diagnostic evaluation. Code 25101 describes wrist-joint exploration or treatment rather than a biopsy-focused service.

Can the tissue examination be billed separately?

The operative service covers access to the joint and tissue collection. A laboratory or pathologist may report the examination of the submitted specimen as a separate service when performed.

How is a biopsy of both wrists reported?

CMS lists this as a bilateral procedure; modifier 50 is paid at 150%. The operative documentation should support biopsy of both wrist joints.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant surgeon be reported?

Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted for this code under the CMS facts provided.

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
RVUs for 25100PPRRVU2026_Oct_nonQPP.csv, line 2,387 (RVU26D)

Open CMS sourceHow we calculate rates

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