No office rate
Choose 25100 when the wrist arthrotomy is performed to obtain a joint biopsy. Choose 25101 for exploration, drainage, or foreign body removal instead.
On this page
CMS RVU26D · Effective 2026-10-01
25101 Wrist arthrotomy Medicare reimbursement rates in Idaho
Report open wrist joint exploration, drainage, or foreign body removal when the surgeon enters the joint to evaluate or treat an identified problem. Compare 25101 office and facility rates across CMS payment localities in Idaho.
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 25101 in Idaho?
Idaho 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
$359.61
1 of 1 localities have a supported rate.
Payment area: Idaho
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 surgery
About 25101: Open wrist joint exploration or drainage
Report open wrist joint exploration, drainage, or foreign body removal when the surgeon enters the joint to evaluate or treat an identified problem.
This service involves opening the wrist joint through an incision so the surgeon can inspect the joint, drain it, or remove a foreign body. It may be performed by an orthopedic or hand surgeon in a hospital or ambulatory surgery setting. The operative report should identify the wrist joint and describe the findings and the work performed, such as the exploration, drainage, or foreign body extraction.
Report this code when the documented procedure matches that open joint work; a biopsy or removal of synovial tissue is a different service. CMS assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one 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 requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 25101
- 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU4.71 · 40%
- Practice expense (office) RVU6.11 · 52%
- Malpractice RVU0.92 · 8%
402
Medicare services in 2024 · #3733 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.
25101 compared with similar codes
Office rates for Idaho, from the same CMS release.
No office rate
25105 describes wrist joint synovectomy. 25101 applies when the documented work is exploration, drainage, or foreign body removal rather than synovial lining excision.
No office rate
25107 is for removal of wrist joint cartilage. It is not the code for general joint exploration, drainage, or foreign body removal.
Compare 25101 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
Idaho →
Office / nonfacility
Unavailable
Facility
$359.61
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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 25101 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
2,388
- Code
- 25101
- Physician work
- 4.71
- Practice expense
- 6.11
- Malpractice
- 0.92
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.71 | × 1.000 | 4.7100 |
| Practice expense | 6.11 | × 0.920 | 5.6212 |
| Malpractice | 0.92 | × 0.473 | 0.4352 |
| Total RVUs | 10.7664 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Idaho$359.61
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.71 | 1 |
| Practice expense | 6.11 | 0.92 |
| Malpractice | 0.92 | 0.473 |
(4.71 × 1 + 6.11 × 0.92 + 0.92 × 0.473) × $33.4009 = $359.61
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.
25101 billing questions
How does this differ from 25100?
25101 is for open exploration, drainage, or foreign body removal from the wrist joint. Use 25100 when the arthrotomy is performed for a joint biopsy.
When is 25105 more appropriate?
Use 25105 when the surgeon performs a wrist joint synovectomy, removing synovial lining. Exploration or drainage without that synovectomy is the work described by 25101.
What should the operative note document?
Document the wrist joint entered, the reason for the arthrotomy, and whether the surgeon explored the joint, drained it, or removed a foreign body.
How is bilateral surgery reported?
For bilateral wrist procedures, report modifier 50; CMS pays this code at 150% when reported bilaterally.
Can an assistant surgeon be reported?
Assistant-at-surgery payment is available only when medical necessity is documented. Co-surgeons and team surgery are not permitted for this code.
How does the multiple-procedure reduction affect payment?
When this procedure is performed with other procedures in the same session, CMS pays the highest-valued procedure in full and applies the standard 50% reduction to the others.
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.
2,38525078,,Resect forarm/wrist tum 3cm>,A,,17.25,11.26,NA,11.26,,3.89,32.40,32.40,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,38625085,,Incision of wrist capsule,A,,5.50,6.20,NA,6.20,,1.06,12.76,12.76,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,38725100,,Biopsy of wrist joint,A,,3.92,5.63,NA,5.63,,0.84,10.39,10.39,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,38825101,,Explore/treat wrist joint,A,,4.71,6.11,NA,6.11,,0.92,11.74,11.74,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,38925105,,Remove wrist joint lining,A,,5.87,6.89,NA,6.89,,1.14,13.90,13.90,0,090,0.10,0.69,0.21,2,1,0,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,39025107,,Remove wrist joint cartilage,A,,7.51,8.64,NA,8.64,,1.45,17.60,17.60,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,39125109,,Excise tendon forearm/wrist,A,,6.77,7.09,NA,7.09,,1.29,15.15,15.15,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772