No office rate
25441 is limited to prosthetic replacement of the distal radius. Use 25446 when the operative reconstruction also replaces the carpus.
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CMS RVU26D · Effective 2026-10-01
25446 Wrist arthroplasty Medicare reimbursement rates in Idaho
Reports prosthetic wrist joint replacement involving both the distal radius and carpus, typically for advanced joint destruction requiring reconstruction of both sides. Compare 25446 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 25446 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
$963.76
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 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 Idaho, from the same CMS release.
No office rate
25442 addresses prosthetic arthroplasty of the distal ulna. It does not describe replacement of the distal radius and carpus together.
No office rate
25445 is for prosthetic arthroplasty of the trapezium, not a wrist joint replacement involving the distal radius and carpus.
No office rate
25449 describes revision wrist arthroplasty. Choose it for revision surgery rather than an initial prosthetic replacement involving the distal radius and carpus.
Compare 25446 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
$963.76
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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 25446 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
2,463
- Code
- 25446
- Physician work
- 16.87
- Practice expense
- 11.34
- Malpractice
- 3.28
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 16.87 | × 1.000 | 16.8700 |
| Practice expense | 11.34 | × 0.920 | 10.4328 |
| Malpractice | 3.28 | × 0.473 | 1.5514 |
| Total RVUs | 28.8542 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Idaho$963.76
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 16.87 | 1 |
| Practice expense | 11.34 | 0.92 |
| Malpractice | 3.28 | 0.473 |
(16.87 × 1 + 11.34 × 0.92 + 3.28 × 0.473) × $33.4009 = $963.76
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.
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.
2,46025443,,Arthrp prostc dstl scph crpl,A,,10.39,9.49,NA,9.49,,2.20,22.08,22.08,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,46125444,,Arthrp w/prostc lunate,A,,11.13,9.46,NA,9.46,,2.15,22.74,22.74,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,46225445,,Arthrp w/prostc trapezium,A,,9.63,8.39,NA,8.39,,1.86,19.88,19.88,0,090,0.10,0.69,0.21,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,46325446,,Arthrp w/prostc dst rds&crps,A,,16.87,11.34,NA,11.34,,3.28,31.49,31.49,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,46425447,,Arthrp ntrcrp/crp/mtcr ntrps,A,,10.24,10.07,NA,10.07,,1.96,22.27,22.27,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,46525448,,Arthrp ntrcrpl/crp/mtcrp ssp,A,,11.55,10.78,NA,10.78,,2.20,24.53,24.53,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,46625449,,Revj arthrp wrist joint,A,,14.57,10.53,NA,10.53,,2.81,27.91,27.91,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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