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Billing code 25445: Trapezium arthroplastyMedicare rate & RVUs

Reports operative arthroplasty replacing the trapezium with a prosthesis, commonly selected for reconstruction of painful thumb-base joint disease.

CMS RVU26DEffective Oct 1, 2026109 payment localities427 Medicare services in 2024

Medicare pays $664.01 for 25445 nationally in a facility.

Medicare rate · 25445

Trapezium arthroplasty

Swap in your local Medicare rate.

Work RVUs
9.63
Total RVUs
19.88
Global days
090

National rate · 2026

$664.01

Facility setting, before claim adjustments.

See every locality for 25445 → · 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 25445 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 25445 covers

This service is an operative arthroplasty in which a prosthetic implant replaces the trapezium, the carpal bone at the base of the thumb. It is most often encountered in reconstruction for painful thumb carpometacarpal disease when the surgeon selects a trapezial prosthesis. An orthopedic hand surgeon typically performs the procedure in an operating room, such as in a hospital outpatient department or ambulatory surgery center.

Report the code when the operative record supports prosthetic replacement of the trapezium, rather than trapeziectomy with interposition or suspensionplasty. Documentation should identify the treated side, the operative indication, and the prosthetic replacement performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care through day 90. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 for bilateral surgery is paid at 150%. Assistant-at-surgery payment is restricted; co-surgeons are paid only with 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 25445 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

25445 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$602.02
Alaska*Unavailable$815.16
ArizonaUnavailable$646.38
ArkansasUnavailable$594.37
AtlantaUnavailable$681.95
AustinUnavailable$673.82
BakersfieldUnavailable$672.73
Baltimore/Surr. CntysUnavailable$704.34
BeaumontUnavailable$634.38
BrazoriaUnavailable$650.39

25445 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
25445 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 25445 rate is calculated

Each of 25445’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 · 25445

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 9.63Practice expense 8.39Malpractice 1.86

19.8800 adjusted RVUs×$33.4009 conversion factor=$664.01

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

Payment rules and modifiers for 25445

25445 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 25445

Trapezium arthroplasty

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)1Not paid (statutory restriction).
Co-surgeons (62)1Permitted with supporting documentation.
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 · 25445

Trapezium arthroplasty

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

25445 without 50 · national facility

$664.01

Trapezium arthroplasty

25445-50 · Bilateral: 150%

$996.02

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

25445 compared with similar codes

Compare codes

25445 vs 25447 vs 25448 vs 25443 vs 25446: national Medicare rates

Swap in your local Medicare rate.

  • 25445
    Trapezium arthroplasty · 9.63 wRVU
    —
  • 25447
    Interposition arthroplasty · 10.24 wRVU
    —
  • 25448
    Wrist arthroplasty · 11.55 wRVU
    —
  • 25443
    Wrist arthroplasty · 10.39 wRVU
    —
  • 25446
    Wrist arthroplasty · 16.87 wRVU
    —

How to choose

25447Interposition arthroplasty
Choose 25445 for prosthetic replacement of the trapezium. Choose 25447 when the surgeon performs interposition arthroplasty instead.
25448Wrist arthroplasty
25448 represents suspensionplasty at intercarpal or carpometacarpal joints; 25445 is for prosthetic replacement of the trapezium.
25443Wrist arthroplasty
Both involve prosthetic replacement arthroplasty, but 25443 applies to the scaphoid and 25445 to the trapezium.
25446Wrist arthroplasty
25446 covers prosthetic arthroplasty involving the distal radius and carpal bones; 25445 identifies trapezium replacement.

Codes related to 25445

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

Codes related to 25445
CodeHow it relatesNational office range
Used instead
25447Interposition arthroplastyInterposition arthroplasty is a different approach to intercarpal or carpometacarpal joint reconstruction.No office rate
25448Wrist arthroplastySuspensionplasty is an alternative carpometacarpal reconstruction technique, not prosthetic trapezium replacement.No office rate
Same family
25443Wrist arthroplastyProsthetic replacement arthroplasty directed to the scaphoid rather than the trapezium.No office rate
25444Wrist arthroplastyProsthetic replacement arthroplasty directed to the lunate rather than the trapezium.No office rate
25446Wrist arthroplastyProsthetic arthroplasty involving the distal radius and carpal bones rather than the trapezium alone.No office rate

25445 billing questions

How does this differ from trapeziectomy with interposition?

Report 25445 when the surgeon replaces the trapezium with a prosthesis. Interposition arthroplasty is a different technique and is represented by 25447.

Is related postoperative care included?

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

How is bilateral surgery reported?

For bilateral procedures, modifier 50 applies; CMS pays the service at 150%.

What happens when another procedure is performed in the same session?

CMS pays the highest-valued procedure in full and other procedures at 50% under the standard multiple procedure reduction.

Can an assistant surgeon be paid for this procedure?

CMS applies a statutory restriction on assistant-at-surgery payment for this code. Co-surgeon payment is allowed only with supporting documentation.

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 25445PPRRVU2026_Oct_nonQPP.csv, line 2,462 (RVU26D)

Open CMS sourceHow we calculate rates

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