25441 is limited to prosthetic replacement of the distal radius. Use 25446 when the operative reconstruction also replaces the carpus.
On this page
CMS RVU26D · Effective 2026-10-01
25446 in Austin
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$1062.40
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Orthopedic surgery
About 25446: Total wrist replacement with prosthesis
Reports prosthetic wrist joint replacement involving both the distal radius and carpus, typically for advanced joint destruction requiring reconstruction of both sides.
This code represents prosthetic replacement of the wrist joint involving the distal radius and the carpal side of the joint. An orthopedic hand or wrist surgeon typically performs the operation in a surgical facility for advanced wrist joint destruction, such as severe degenerative or post-traumatic arthritis, when the operative plan replaces both areas.
Select this code when the operative report documents prosthetic replacement of the distal radius and carpus together; replacement limited to the distal radius, ulna, or an individual carpal bone is reported with a more specific code. Document the side, structures replaced, and prosthetic reconstruction, and distinguish an initial replacement from revision surgery. Medicare 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 may be made; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 25446
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU16.87 · 54%
- Practice expense (office) RVU11.34 · 36%
- Malpractice RVU3.28 · 10%
194
Medicare services in 2024 · #4347 by national volume
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.
25446 compared with similar codes
Office rates for Austin, from the same CMS release.
25442 addresses prosthetic arthroplasty of the distal ulna. It does not describe replacement of the distal radius and carpus together.
25445 is for prosthetic arthroplasty of the trapezium, not a wrist joint replacement involving the distal radius and carpus.
25449 describes revision wrist arthroplasty. Choose it for revision surgery rather than an initial prosthetic replacement involving the distal radius and carpus.
The same code, a different location
How does Austin compare?
25446 across payment areas
Same release and payment basis · bars start at $0
Austin · This locality
Unavailable
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Other payment areas listed in Texas appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Rest Of Texas
Texas · 25446
Office
Unavailable
Facility
$1021.85
No comparable office rate is available.
Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)
California · 25446
Office
Unavailable
Facility
$1107.40
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 25446
Office
Unavailable
Facility
$1162.02
No comparable office rate is available.
Miami
Florida · 25446
Office
Unavailable
Facility
$1234.83
No comparable office rate is available.
Chicago
Illinois · 25446
Office
Unavailable
Facility
$1199.51
No comparable office rate is available.
Manhattan
New York · 25446
Office
Unavailable
Facility
$1213.42
No comparable office rate is available.
Alaska*
Alaska · 25446
Office
Unavailable
Facility
$1308.96
No comparable office rate is available.
Alabama
Alabama · 25446
Office
Unavailable
Facility
$956.90
No comparable office rate is available.
Arkansas
Arkansas · 25446
Office
Unavailable
Facility
$945.25
No comparable office rate is available.
Arizona
Arizona · 25446
Office
Unavailable
Facility
$1024.28
No comparable office rate is available.
Bakersfield
California · 25446
Office
Unavailable
Facility
$1056.03
No comparable office rate is available.
Chico
California · 25446
Office
Unavailable
Facility
$1046.90
No comparable office rate is available.
El Centro
California · 25446
Office
Unavailable
Facility
$1047.45
No comparable office rate is available.
Fresno
California · 25446
Office
Unavailable
Facility
$1046.90
No comparable office rate is available.
Hanford-Corcoran
California · 25446
Office
Unavailable
Facility
$1046.90
No comparable office rate is available.
Madera
California · 25446
Office
Unavailable
Facility
$1046.90
No comparable office rate is available.
Merced
California · 25446
Office
Unavailable
Facility
$1046.90
No comparable office rate is available.
Modesto
California · 25446
Office
Unavailable
Facility
$1046.90
No comparable office rate is available.
Napa
California · 25446
Office
Unavailable
Facility
$1153.84
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 25446
Office
Unavailable
Facility
$1095.20
No comparable office rate is available.
Redding
California · 25446
Office
Unavailable
Facility
$1046.90
No comparable office rate is available.
Rest Of California
California · 25446
Office
Unavailable
Facility
$1046.90
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 25446
Office
Unavailable
Facility
$1082.19
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 25446
Office
Unavailable
Facility
$1082.98
No comparable office rate is available.
Salinas
California · 25446
Office
Unavailable
Facility
$1078.65
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 25446
Office
Unavailable
Facility
$1092.76
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 25446
Office
Unavailable
Facility
$1201.35
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 25446
Office
Unavailable
Facility
$1197.62
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 25446
Office
Unavailable
Facility
$1230.36
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 25446
Office
Unavailable
Facility
$1215.13
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 25446
Office
Unavailable
Facility
$1063.19
No comparable office rate is available.
Santa Cruz-Watsonville
California · 25446
Office
Unavailable
Facility
$1094.23
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 25446
Office
Unavailable
Facility
$1079.61
No comparable office rate is available.
Santa Rosa-Petaluma
California · 25446
Office
Unavailable
Facility
$1104.22
No comparable office rate is available.
Stockton
California · 25446
Office
Unavailable
Facility
$1046.90
No comparable office rate is available.
Vallejo
California · 25446
Office
Unavailable
Facility
$1148.47
No comparable office rate is available.
Visalia
California · 25446
Office
Unavailable
Facility
$1046.90
No comparable office rate is available.
Yuba City
California · 25446
Office
Unavailable
Facility
$1046.90
No comparable office rate is available.
Colorado
Colorado · 25446
Office
Unavailable
Facility
$1058.80
No comparable office rate is available.
Connecticut
Connecticut · 25446
Office
Unavailable
Facility
$1115.24
No comparable office rate is available.
Delaware
Delaware · 25446
Office
Unavailable
Facility
$1039.00
No comparable office rate is available.
Fort Lauderdale
Florida · 25446
Office
Unavailable
Facility
$1145.24
No comparable office rate is available.
Rest Of Florida
Florida · 25446
Office
Unavailable
Facility
$1090.23
No comparable office rate is available.
Atlanta
Georgia · 25446
Office
Unavailable
Facility
$1081.57
No comparable office rate is available.
Rest Of Georgia
Georgia · 25446
Office
Unavailable
Facility
$1031.92
No comparable office rate is available.
Hawaii, Guam
Hawaii · 25446
Office
Unavailable
Facility
$1057.56
No comparable office rate is available.
Iowa
Iowa · 25446
Office
Unavailable
Facility
$953.54
No comparable office rate is available.
Idaho
Idaho · 25446
Office
Unavailable
Facility
$963.76
No comparable office rate is available.
East St. Louis
Illinois · 25446
Office
Unavailable
Facility
$1132.58
No comparable office rate is available.
Rest Of Illinois
Illinois · 25446
Office
Unavailable
Facility
$1080.52
No comparable office rate is available.
Suburban Chicago
Illinois · 25446
Office
Unavailable
Facility
$1150.54
No comparable office rate is available.
Indiana
Indiana · 25446
Office
Unavailable
Facility
$967.83
No comparable office rate is available.
Kansas
Kansas · 25446
Office
Unavailable
Facility
$961.09
No comparable office rate is available.
Kentucky
Kentucky · 25446
Office
Unavailable
Facility
$1000.44
No comparable office rate is available.
New Orleans
Louisiana · 25446
Office
Unavailable
Facility
$1044.35
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 25446
Office
Unavailable
Facility
$1003.63
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 25446
Office
Unavailable
Facility
$1136.33
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 25446
Office
Unavailable
Facility
$1058.64
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 25446
Office
Unavailable
Facility
$1114.42
No comparable office rate is available.
Rest Of Maryland
Maryland · 25446
Office
Unavailable
Facility
$1052.99
No comparable office rate is available.
Rest Of Maine
Maine · 25446
Office
Unavailable
Facility
$980.08
No comparable office rate is available.
Southern Maine
Maine · 25446
Office
Unavailable
Facility
$1007.96
No comparable office rate is available.
Detroit
Michigan · 25446
Office
Unavailable
Facility
$1113.69
No comparable office rate is available.
Rest Of Michigan
Michigan · 25446
Office
Unavailable
Facility
$1032.97
No comparable office rate is available.
Minnesota
Minnesota · 25446
Office
Unavailable
Facility
$985.65
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 25446
Office
Unavailable
Facility
$1026.17
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 25446
Office
Unavailable
Facility
$1033.83
No comparable office rate is available.
Rest Of Missouri
Missouri · 25446
Office
Unavailable
Facility
$996.68
No comparable office rate is available.
Mississippi
Mississippi · 25446
Office
Unavailable
Facility
$970.55
No comparable office rate is available.
Montana**
Montana · 25446
Office
Unavailable
Facility
$1051.58
No comparable office rate is available.
North Carolina
North Carolina · 25446
Office
Unavailable
Facility
$986.87
No comparable office rate is available.
North Dakota**
North Dakota · 25446
Office
Unavailable
Facility
$986.72
No comparable office rate is available.
Nebraska
Nebraska · 25446
Office
Unavailable
Facility
$954.49
No comparable office rate is available.
New Hampshire
New Hampshire · 25446
Office
Unavailable
Facility
$1053.63
No comparable office rate is available.
Northern Nj
New Jersey · 25446
Office
Unavailable
Facility
$1155.35
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 25446
Office
Unavailable
Facility
$1119.81
No comparable office rate is available.
New Mexico
New Mexico · 25446
Office
Unavailable
Facility
$1042.38
No comparable office rate is available.
Nevada**
Nevada · 25446
Office
Unavailable
Facility
$1033.88
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 25446
Office
Unavailable
Facility
$1253.33
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 25446
Office
Unavailable
Facility
$1136.14
No comparable office rate is available.
Queens
New York · 25446
Office
Unavailable
Facility
$1205.22
No comparable office rate is available.
Rest Of New York
New York · 25446
Office
Unavailable
Facility
$1000.32
No comparable office rate is available.
Ohio
Ohio · 25446
Office
Unavailable
Facility
$1019.72
No comparable office rate is available.
Oklahoma
Oklahoma · 25446
Office
Unavailable
Facility
$986.84
No comparable office rate is available.
Portland
Oregon · 25446
Office
Unavailable
Facility
$1074.81
No comparable office rate is available.
Rest Of Oregon
Oregon · 25446
Office
Unavailable
Facility
$1017.74
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 25446
Office
Unavailable
Facility
$1098.61
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 25446
Office
Unavailable
Facility
$1014.71
No comparable office rate is available.
Puerto Rico
Puerto Rico · 25446
Office
Unavailable
Facility
$1054.32
No comparable office rate is available.
Rhode Island
Rhode Island · 25446
Office
Unavailable
Facility
$1063.17
No comparable office rate is available.
South Carolina
South Carolina · 25446
Office
Unavailable
Facility
$1006.57
No comparable office rate is available.
South Dakota**
South Dakota · 25446
Office
Unavailable
Facility
$979.05
No comparable office rate is available.
Tennessee
Tennessee · 25446
Office
Unavailable
Facility
$966.60
No comparable office rate is available.
Utah
Utah · 25446
Office
Unavailable
Facility
$1017.89
No comparable office rate is available.
Virginia
Virginia · 25446
Office
Unavailable
Facility
$1013.15
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 25446
Office
Unavailable
Facility
$1054.32
No comparable office rate is available.
Vermont
Vermont · 25446
Office
Unavailable
Facility
$993.89
No comparable office rate is available.
Rest Of Washington
Washington · 25446
Office
Unavailable
Facility
$1053.01
No comparable office rate is available.
Seattle (King Cnty)
Washington · 25446
Office
Unavailable
Facility
$1145.90
No comparable office rate is available.
Wisconsin
Wisconsin · 25446
Office
Unavailable
Facility
$960.07
No comparable office rate is available.
West Virginia
West Virginia · 25446
Office
Unavailable
Facility
$1049.39
No comparable office rate is available.
Wyoming**
Wyoming · 25446
Office
Unavailable
Facility
$1023.31
No comparable office rate is available.
See how rates vary across the country
25446 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Austin is a Medicare payment area. Our Census mapping connects it to 31 cities and communities in Texas, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
- 25446 in Austin
Multiple payment areas
- 25446 in Barton Creek
- 25446 in Bee Cave
- 25446 in Briarcliff
- 25446 in Cedar Park
Multiple payment areas
- 25446 in Creedmoor
Multiple payment areas
- 25446 in Elgin
Multiple payment areas
- 25446 in Garfield
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 25446 in Austin. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$1168.64
$1062.40 × 110% = $1168.64
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 25446 in Austin.
PPRRVU2026_Oct_nonQPP.csv
2,463
- Code
- 25446
- Physician work
- 16.87
- Practice expense
- 11.34
- Malpractice
- 3.28
GPCI2026.csv
96
- Locality
- Austin
- Physician work
- 1.002
- Practice expense
- 1.058
- Malpractice
- 0.886
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 16.87 | × 1.002 | 16.9037 |
| Practice expense | 11.34 | × 1.058 | 11.9977 |
| Malpractice | 3.28 | × 0.886 | 2.9061 |
| Total RVUs | 31.8075 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Austin$1062.40
Open 25446 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 16.87 | 1.002 |
| Practice expense | 11.34 | 1.058 |
| Malpractice | 3.28 | 0.886 |
(16.87 × 1.002 + 11.34 × 1.058 + 3.28 × 0.886) × $33.4009 = $1062.40
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
25446 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $1062.40 | RVU26D |
| 2026-07-01 | Not available in this setting | $1062.40 | RVU26C |
| 2026-04-01 | Not available in this setting | $1062.40 | RVU26B |
| 2026-01-01 | Not available in this setting | $1062.40 | RVU26A |
| 2025-10-01 | Not available in this setting | $1167.81 | RVU25D |
| 2025-07-01 | Not available in this setting | $1167.81 | RVU25C |
| 2025-04-01 | Not available in this setting | $1167.81 | RVU25B |
| 2025-01-01 | Not available in this setting | $1167.81 | RVU25A |
25446 billing questions
When should this code be used instead of 25441?
Use 25446 when the prosthetic reconstruction replaces both the distal radius and carpus. Code 25441 describes prosthetic arthroplasty limited to the distal radius.
How does this differ from 25449?
25446 describes the replacement procedure involving the distal radius and carpus. Code 25449 is for revision wrist arthroplasty; use the code that matches whether the operation is an initial replacement or a revision.
What operative documentation supports 25446?
The operative report should identify the side, the distal radius and carpal structures replaced, and the prosthetic reconstruction performed.
How is bilateral surgery reported?
Report bilateral performance with modifier 50. CMS pays bilateral procedures at 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What postoperative care is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
