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Billing code 25449: Wrist revisionMedicare rate & RVUs

Revision wrist arthroplasty addresses a previously replaced wrist joint when the existing prosthetic reconstruction requires operative revision.

CMS RVU26DEffective Oct 1, 2026109 payment localities148 Medicare services in 2024

Medicare pays $932.22 for 25449 nationally in a facility.

Medicare rate · 25449

Wrist revision

Swap in your local Medicare rate.

Work RVUs
14.57
Total RVUs
27.91
Global days
090

National rate · 2026

$932.22

Facility setting, before claim adjustments.

See every locality for 25449 → · 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 25449 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 25449 covers

An orthopedic or hand surgeon revises a previously performed wrist joint arthroplasty when the prosthetic reconstruction has failed or requires correction. The operation may address problems such as implant loosening, wear, or instability. These procedures are generally performed in an operating room, with the operative report describing the prior reconstruction and the revision work performed on the wrist joint and implant construct.

Report this code for revision of an existing wrist arthroplasty, not for a first-time prosthetic replacement. Documentation should establish the prior arthroplasty, the reason for revision, and the work performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. 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. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; 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 25449 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

25449 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$847.52
Alaska*Unavailable$1,156.26
ArizonaUnavailable$907.80
ArkansasUnavailable$837.11
AtlantaUnavailable$958.17
AustinUnavailable$942.89
BakersfieldUnavailable$938.53
Baltimore/Surr. CntysUnavailable$987.92
BeaumontUnavailable$893.90
BrazoriaUnavailable$912.30

25449 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
25449 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 25449 rate is calculated

Each of 25449’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 · 25449

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 14.57Practice expense 10.53Malpractice 2.81

27.9100 adjusted RVUs×$33.4009 conversion factor=$932.22

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

Payment rules and modifiers for 25449

25449 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 25449

Wrist revision

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)2Paid.
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 · 25449

Wrist revision

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

25449 without 50 · national facility

$932.22

Wrist revision

25449-50 · Bilateral: 150%

$1,398.33

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

25449 compared with similar codes

Compare codes

25449 vs 25441 vs 25443 vs 25446: national Medicare rates

Swap in your local Medicare rate.

  • 25449
    Wrist revision · 14.57 wRVU
    —
  • 25441
    Wrist arthroplasty · 12.96 wRVU
    —
  • 25443
    Wrist arthroplasty · 10.39 wRVU
    —
  • 25446
    Wrist arthroplasty · 16.87 wRVU
    —

How to choose

25441Wrist arthroplasty
25441 describes primary prosthetic arthroplasty of the distal radius. Use 25449 when the operative service revises an existing wrist arthroplasty.
25443Wrist arthroplasty
25443 is a primary prosthetic arthroplasty involving the distal scaphoid. It is not the revision code for a previously performed wrist arthroplasty.
25446Wrist arthroplasty
25446 describes primary prosthetic arthroplasty involving the distal radius and carpal bones; 25449 is for revision of an existing wrist arthroplasty.

Codes related to 25449

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

Codes related to 25449
CodeHow it relatesNational office range
Same family
25441Wrist arthroplastyPrimary prosthetic arthroplasty of the distal radius, rather than revision of an existing wrist arthroplasty.No office rate
25442Ulna arthroplastyPrimary prosthetic arthroplasty of the distal ulna; 25449 describes revision of a prior wrist arthroplasty.No office rate
25443Wrist arthroplastyPrimary prosthetic arthroplasty involving the distal scaphoid; distinguish it from wrist arthroplasty revision.No office rate
25444Wrist arthroplastyPrimary prosthetic arthroplasty of the lunate, not revision of a previously replaced wrist joint.No office rate
25446Wrist arthroplastyPrimary prosthetic arthroplasty involving the distal radius and carpal bones.No office rate

25449 billing questions

When should this code be chosen instead of a primary wrist arthroplasty code?

Use 25449 when the surgeon revises a wrist joint that has already undergone arthroplasty. A first-time prosthetic replacement is represented by a code for the specific joint or bone being replaced.

What documentation supports reporting a revision?

Document the prior wrist arthroplasty, the reason it requires revision, and the specific revision work performed. The operative report should make clear that the procedure addresses the existing arthroplasty rather than creating a primary replacement.

How does the 90-day global period affect postoperative billing?

The day-before preoperative visit and 90 days of related postoperative care are included in the global period. The surgeon's related routine follow-up care during that period is part of the surgical package.

How is the code treated when other procedures are performed in the same session?

The highest-valued procedure is paid in full, and other procedures in that session are subject to the standard multiple procedure reduction.

Can modifier 50 be used for bilateral wrist revisions?

CMS identifies this as a bilateral procedure; bilateral reporting with modifier 50 is paid at 150%.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be available. Co-surgeons are paid only when supporting documentation is 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 25449PPRRVU2026_Oct_nonQPP.csv, line 2,466 (RVU26D)

Open CMS sourceHow we calculate rates

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