Billing code 25635: Carpal fracture treatmentMedicare rate & RVUs
Reports closed manipulation to realign a fractured carpal bone other than the scaphoid, with separate reporting for each bone treated.
Medicare pays $520.72 for 25635 nationally in the office and $423.19 in a hospital or facility. Local office rates run $457.41–$672.04.
Medicare rate · 25635
Carpal fracture treatment
- Work RVUs
- 4.49
- Total RVUs
- 15.59
- Global days
- 090
National rate · 2026
$520.72
Office setting, before claim adjustments.
See every locality for 25635 →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
What 25635 covers
An orthopedist, hand surgeon, or other qualified treating clinician reports this service when a carpal fracture other than a scaphoid fracture is treated without surgical exposure and requires manipulation to restore alignment. Examples of eligible bones include the triquetrum, lunate, capitate, hamate, trapezium, trapezoid, and pisiform. Treatment may occur in an emergency department, clinic, or other setting where the clinician provides fracture care.
Select the code for each bone treated and document the fracture site, laterality, closed approach, and the manipulation performed. A fracture treated without manipulation is reported with 25630; scaphoid fractures belong to their own code family. The 90-day global includes 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 25635 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$457.41 to $672.04
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $464.47 | $379.13 |
| Alaska* | $603.32 | $499.45 |
| Arizona | $505.60 | $411.10 |
| Arkansas | $457.41 | $373.64 |
| Atlanta | $533.03 | $433.94 |
| Austin | $537.01 | $433.82 |
| Bakersfield | $543.55 | $436.65 |
| Baltimore/Surr. Cntys | $555.44 | $450.79 |
| Beaumont | $487.96 | $399.21 |
| Brazoria | $511.82 | $415.16 |
| Chicago | $564.99 | $466.97 |
| Chico | $540.91 | $434.01 |
| Colorado | $537.17 | $433.40 |
| Connecticut | $556.53 | $451.49 |
| Dallas | $516.16 | $419.02 |
| Dc + Md/Va Suburbs | $592.73 | $477.84 |
| Delaware | $514.17 | $417.81 |
| Detroit | $530.86 | $436.75 |
| East St. Louis | $526.14 | $436.41 |
| El Centro | $541.07 | $434.17 |
| Fort Lauderdale | $551.03 | $452.23 |
| Fort Worth | $513.19 | $417.03 |
| Fresno | $540.91 | $434.01 |
| Galveston | $514.03 | $417.19 |
| Hanford-Corcoran | $540.91 | $434.01 |
| Hawaii, Guam | $553.62 | $442.73 |
| Houston | $531.61 | $434.76 |
| Idaho | $476.73 | $387.00 |
| Indiana | $479.51 | $389.10 |
| Iowa | $472.60 | $383.36 |
| Kansas | $472.30 | $384.13 |
| Kentucky | $480.40 | $393.70 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $578.07 | $462.70 |
| Madera | $540.91 | $434.01 |
| Manhattan | $603.98 | $490.64 |
| Merced | $540.91 | $434.01 |
| Metropolitan Boston | $589.05 | $472.60 |
| Metropolitan Kansas City | $499.32 | $407.74 |
| Metropolitan Philadelphia | $543.49 | $441.96 |
| Metropolitan St. Louis | $504.53 | $411.68 |
| Miami | $583.63 | $482.10 |
| Minnesota | $507.97 | $407.61 |
| Mississippi | $465.27 | $381.30 |
| Modesto | $540.91 | $434.01 |
| Montana** | $520.66 | $423.13 |
| Napa | $622.09 | $493.55 |
| Nebraska | $474.70 | $384.68 |
| Nevada** | $515.70 | $418.08 |
| New Hampshire | $530.60 | $429.07 |
| New Mexico | $499.05 | $409.62 |
| New Orleans | $505.10 | $413.32 |
| North Carolina | $486.45 | $395.46 |
| North Dakota** | $501.67 | $404.14 |
| Northern Nj | $586.54 | $473.40 |
| Nyc Suburbs/Long Island | $621.81 | $505.85 |
| Ohio | $491.51 | $402.47 |
| Oklahoma | $477.33 | $390.24 |
| Oxnard-Thousand Oaks-Ventura | $574.47 | $459.19 |
| Portland | $552.50 | $444.15 |
| Poughkpsie/N Nyc Suburbs | $566.38 | $459.58 |
| Puerto Rico | $523.96 | $425.36 |
| Queens | $606.13 | $490.85 |
| Redding | $540.91 | $434.01 |
| Rest Of California | $540.91 | $434.01 |
| Rest Of Florida | $521.95 | $428.71 |
| Rest Of Georgia | $490.30 | $403.30 |
| Rest Of Illinois | $509.31 | $420.26 |
| Rest Of Louisiana | $480.42 | $394.11 |
| Rest Of Maine | $481.50 | $391.78 |
| Rest Of Maryland | $523.65 | $424.95 |
| Rest Of Massachusetts | $534.56 | $431.86 |
| Rest Of Michigan | $495.39 | $406.35 |
| Rest Of Missouri | $473.15 | $389.08 |
| Rest Of New Jersey | $560.99 | $454.48 |
| Rest Of New York | $494.26 | $401.61 |
| Rest Of Oregon | $509.84 | $412.70 |
| Rest Of Pennsylvania | $491.18 | $401.65 |
| Rest Of Texas | $500.34 | $407.78 |
| Rest Of Washington | $532.96 | $430.26 |
| Rhode Island | $531.28 | $430.53 |
| Riverside-San Bernardino-Ontario | $551.22 | $444.33 |
| Sacramento-Roseville-Folsom | $566.45 | $453.02 |
| Salinas | $564.34 | $451.30 |
| San Diego-Chula Vista-Carlsbad | $576.92 | $460.27 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $656.48 | $518.96 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $655.39 | $517.87 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $672.04 | $531.40 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $667.58 | $526.94 |
| San Luis Obispo-Paso Robles | $555.47 | $444.38 |
| Santa Cruz-Watsonville | $581.81 | $463.31 |
| Santa Maria-Santa Barbara | $566.26 | $452.54 |
| Santa Rosa-Petaluma | $587.56 | $467.79 |
| Seattle (King Cnty) | $599.23 | $479.56 |
| South Carolina | $490.17 | $400.05 |
| South Dakota** | $499.43 | $401.90 |
| Southern Maine | $505.84 | $409.19 |
| Stockton | $540.91 | $434.01 |
| Suburban Chicago | $555.67 | $455.50 |
| Tennessee | $475.05 | $386.40 |
| Utah | $497.13 | $405.45 |
| Vallejo | $620.52 | $491.98 |
| Vermont | $501.49 | $404.94 |
| Virgin Islands | $523.96 | $425.36 |
| Virginia | $505.54 | $409.66 |
| Visalia | $540.91 | $434.01 |
| West Virginia | $490.17 | $405.42 |
| Wisconsin | $484.31 | $390.87 |
| Wyoming** | $512.38 | $414.85 |
| Yuba City | $540.91 | $434.01 |
25635 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$457.41
$606.47
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $603.32 | 1 |
| AL | $464.47 | 1 |
| AR | $457.41 | 1 |
| AZ | $505.60 | 1 |
| CA | $540.91–$672.04 | 29 |
| CO | $537.17 | 1 |
| CT | $556.53 | 1 |
| DC | $592.73 | 1 |
| DE | $514.17 | 1 |
| FL | $521.95–$583.63 | 3 |
| GA | $490.30–$533.03 | 2 |
| GU | $553.62 | 1 |
| HI | $553.62 | 1 |
| IA | $472.60 | 1 |
| ID | $476.73 | 1 |
| IL | $509.31–$564.99 | 4 |
| IN | $479.51 | 1 |
| KS | $472.30 | 1 |
| KY | $480.40 | 1 |
| LA | $480.42–$505.10 | 2 |
| MA | $534.56–$589.05 | 2 |
| MD | $523.65–$592.73 | 3 |
| ME | $481.50–$505.84 | 2 |
| MI | $495.39–$530.86 | 2 |
| MN | $507.97 | 1 |
| MO | $473.15–$504.53 | 3 |
| MS | $465.27 | 1 |
| MT | $520.66 | 1 |
| NC | $486.45 | 1 |
| ND | $501.67 | 1 |
| NE | $474.70 | 1 |
| NH | $530.60 | 1 |
| NJ | $560.99–$586.54 | 2 |
| NM | $499.05 | 1 |
| NV | $515.70 | 1 |
| NY | $494.26–$621.81 | 5 |
| OH | $491.51 | 1 |
| OK | $477.33 | 1 |
| OR | $509.84–$552.50 | 2 |
| PA | $491.18–$543.49 | 2 |
| PR | $523.96 | 1 |
| RI | $531.28 | 1 |
| SC | $490.17 | 1 |
| SD | $499.43 | 1 |
| TN | $475.05 | 1 |
| TX | $487.96–$537.01 | 8 |
| UT | $497.13 | 1 |
| VA | $505.54–$592.73 | 2 |
| VI | $523.96 | 1 |
| VT | $501.49 | 1 |
| WA | $532.96–$599.23 | 2 |
| WI | $484.31 | 1 |
| WV | $490.17 | 1 |
| WY | $512.38 | 1 |
How the 25635 rate is calculated
Each of 25635’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 · 25635
RVUs × geographic indexes × conversion factor
Work4.49
4.49 RVUs× 1.000 GPCI
Practice expense10.14
10.14 RVUs× 1.000 GPCI
Malpractice0.96
0.96 RVUs× 1.000 GPCI
Adjusted RVUs
15.5900
Conversion factor
$33.4009
Medicare rate
$520.72
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 25635
25635 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 25635
Carpal fracture treatment
| 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 · 25635
Carpal fracture treatment
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
25635 without 50 · national office
$520.72
Carpal fracture treatment
25635-50 · Bilateral: 150%
$781.08
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).
25635 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 25630Carpal fracture care
- Both cover closed treatment of a carpal fracture other than the scaphoid, but 25635 includes manipulation and 25630 does not.
- 25645Carpal fracture repair
- Use 25645 when the other carpal fracture is treated through an open approach; 25635 describes closed treatment with manipulation.
- 25624Scaphoid fracture care
- Code 25624 is for a scaphoid fracture treated with manipulation. Code 25635 is for another carpal bone.
- 25622Scaphoid fracture care
- Code 25622 covers closed treatment of a scaphoid fracture without manipulation; 25635 covers manipulation of a different carpal bone.
25635 billing questions
How does this differ from 25630?
Use 25635 when closed treatment includes manipulation to realign the fracture. Code 25630 is for closed treatment without manipulation.
Can this code be used for a scaphoid fracture?
No. Scaphoid fractures are reported from the scaphoid-specific family, such as 25622 or 25624, depending on whether manipulation is performed.
How many units should be reported?
The code is reported for each carpal bone treated. Document the bone and the manipulation for each treated fracture.
What does the 90-day global include?
It includes the day-before preoperative visit and 90 days of related postoperative care.
How is bilateral treatment reported?
When the service is performed bilaterally, modifier 50 applies; CMS pays the bilateral procedure at 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is available only with documentation of medical necessity. 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
Show the CMS file lines behind this rate
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