$668.16
Use 25605 when performing closed treatment with manipulation of a qualifying distal radius fracture. Code 25259 describes manipulation of the wrist joint under general anesthesia, not fracture treatment as such.
On this page
CMS RVU26D · Effective 2026-10-01
25259 Wrist manipulation Medicare reimbursement rates in Guam
Reports passive mobilization of a stiff wrist joint under general anesthesia, typically to improve motion restricted after injury, immobilization, or surgery. Compare 25259 office and facility rates across CMS payment localities in Guam.
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.
What does Medicare pay for 25259 in Guam?
Guam has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$464.36
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Orthopedic procedure
About 25259: Wrist joint manipulation under anesthesia
Reports passive mobilization of a stiff wrist joint under general anesthesia, typically to improve motion restricted after injury, immobilization, or surgery.
The surgeon moves the wrist through its range while the patient is under general anesthesia, using controlled force to address restricted joint motion. An orthopedic or hand surgeon commonly performs this procedure in an operating room or other surgical setting when stiffness persists after an injury, a period of immobilization, or prior wrist surgery. The record should identify the affected wrist, the reason motion is restricted, and the manipulation performed; pre- and post-manipulation motion findings help show the work and result.
CMS assigns this major surgery 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 the others at 50%. For bilateral reporting with modifier 50, CMS pays at 150%. An assistant at surgery is not paid under the statutory restriction; co-surgeons and team surgery are not permitted.
CMS billing rules for 25259
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU3.94 · 30%
- Practice expense (office) RVU8.36 · 64%
- Malpractice RVU0.79 · 6%
212
Medicare services in 2024 · #4269 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.
25259 compared with similar codes
Office rates for Guam, from the same CMS release.
No office rate
25290 involves cutting a wrist or forearm tendon. Use 25259 when the service is passive wrist joint manipulation under general anesthesia rather than tendon incision.
Compare 25259 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$464.36
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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 25259 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
2,417
- Code
- 25259
- Physician work
- 3.94
- Practice expense
- 8.36
- Malpractice
- 0.79
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.94 | × 1.000 | 3.9400 |
| Practice expense | 8.36 | × 1.137 | 9.5053 |
| Malpractice | 0.79 | × 0.579 | 0.4574 |
| Total RVUs | 13.9027 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$464.36
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.94 | 1 |
| Practice expense | 8.36 | 1.137 |
| Malpractice | 0.79 | 0.579 |
(3.94 × 1 + 8.36 × 1.137 + 0.79 × 0.579) × $33.4009 = $464.36
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.
25259 billing questions
When should this code be used instead of a fracture-treatment code?
Use 25259 for manipulation of the wrist joint under general anesthesia. When the manipulation is part of treating a specific fracture, select the applicable fracture-treatment code, which may include the reduction.
What documentation supports reporting the manipulation?
Document the wrist and side, the cause of restricted motion, the pre-manipulation limitation, the manipulation performed, and the resulting motion. The anesthesia record can support that the procedure was performed under general anesthesia.
Does the code include related postoperative visits?
CMS assigns a 90-day global period. The day-before preoperative visit and 90 days of related postoperative care are included.
How does CMS handle bilateral reporting and other procedures in the same session?
With modifier 50, the bilateral procedure is paid at 150%. For multiple procedures in one session, the highest-valued procedure is paid in full and the others at 50%.
Can an assistant or co-surgeon be reported?
CMS does not pay an assistant at surgery for this code under the statutory restriction. 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 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.
2,41425248,,Remove forearm foreign body,A,,5.18,5.92,NA,5.92,,1.12,12.22,12.22,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,41525250,,Removal of wrist prosthesis,A,,6.60,7.38,NA,7.38,,1.40,15.38,15.38,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,41625251,,Removal of wrist prosthesis,A,,9.57,8.67,NA,8.67,,2.05,20.29,20.29,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,41725259,,Manipulate wrist w/anesthes,A,,3.94,8.36,NA,8.36,,0.79,13.09,13.09,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,41825260,,Repair forearm tendon/muscle,A,,7.84,8.59,NA,8.59,,1.51,17.94,17.94,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,41925263,,Repair forearm tendon/muscle,A,,7.84,8.69,NA,8.69,,1.67,18.20,18.20,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,42025265,,Repair forearm tendon/muscle,A,,9.85,8.91,NA,8.91,,1.84,20.60,20.60,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014