Billing code 25100: Wrist biopsyMedicare rate & RVUs in Illinois
An open wrist arthrotomy to obtain intra-articular tissue for diagnostic evaluation when a surgeon needs a surgical specimen rather than joint fluid alone.
CMS doesn’t publish an office rate for 25100 in Illinois.
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 9 sections
What 25100 covers
The surgeon opens the wrist joint and removes a tissue sample for diagnostic evaluation. The specimen may be synovium or other intra-articular tissue submitted for pathologic or microbiologic study when the cause of persistent synovitis, suspected infection, or another joint abnormality remains uncertain. Orthopedic and hand surgeons typically perform this procedure in a hospital operating room or ambulatory surgery center; it is an open surgical biopsy, not needle aspiration or arthroscopic sampling.
Report the code when the operative record supports an open joint approach and tissue was obtained for biopsy. Document the wrist, operative approach, sampled tissue, and diagnostic purpose. CMS 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 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 25100 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $385.23 |
| East St. Louis | Unavailable | $360.44 |
| Rest Of Illinois | Unavailable | $346.47 |
| Suburban Chicago | Unavailable | $374.69 |
How the 25100 rate is calculated
Each of 25100’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 · 25100
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.92Practice expense 5.63Malpractice 0.84
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 25100
25100 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 25100
Wrist biopsy
| 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 · 25100
Wrist biopsy
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
25100 without 50 · national facility
$347.04
Wrist biopsy
25100-50 · Bilateral: 150%
$520.56
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).
25100 compared with similar codes
Compare codes
25100 vs 25101 vs 29840 vs 20605: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 25101Wrist arthrotomy
- 25100 identifies an open wrist-joint procedure to obtain a diagnostic tissue specimen. 25101 is used when the operative objective is exploration or treatment.
- 29840Wrist arthroscopy
- 29840 is a diagnostic arthroscopic wrist procedure, with or without synovial biopsy. Choose 25100 when the biopsy is performed through an open arthrotomy.
- 20605Joint procedure
- 20605 describes aspiration or injection of an intermediate joint such as the wrist. It involves joint fluid, not an open surgical tissue biopsy.
25100 billing questions
When is this code more appropriate than 25101?
Use 25100 when the surgeon opens the wrist joint to obtain tissue for diagnostic evaluation. Code 25101 describes wrist-joint exploration or treatment rather than a biopsy-focused service.
Can the tissue examination be billed separately?
The operative service covers access to the joint and tissue collection. A laboratory or pathologist may report the examination of the submitted specimen as a separate service when performed.
How is a biopsy of both wrists reported?
CMS lists this as a bilateral procedure; modifier 50 is paid at 150%. The operative documentation should support biopsy of both wrist joints.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon be reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted for this code under the CMS facts provided.
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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