Billing code 25624: Scaphoid fracture careMedicare rate & RVUs in Ohio
Reports closed treatment of a carpal scaphoid fracture when the clinician manipulates the fracture to restore alignment without open fixation.
Medicare pays $518.02 for 25624 in the office in Ohio (Ohio). Which amount applies depends on the service address.
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 25624 covers
An orthopedic or hand surgeon treats a scaphoid fracture through the skin, using external maneuvers to realign the broken carpal bone. This service is typically used when fracture alignment requires manipulation and the clinician can treat the injury without surgically exposing the fracture or placing internal fixation. Immobilization in a cast or splint commonly follows the reduction.
Choose this code when the record identifies a scaphoid fracture and supports manipulation as part of the closed treatment; simple immobilization without manipulation points to a different code. The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. An assistant is paid only when medical necessity is documented; 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.
25624 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $518.02 | $424.10 |
How the 25624 rate is calculated
Each of 25624’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 · 25624
RVUs × geographic indexes × conversion factor
Work4.65
4.65 RVUs× 1.000 GPCI
Practice expense10.79
10.79 RVUs× 1.000 GPCI
Malpractice1.00
1.00 RVUs× 1.000 GPCI
Adjusted RVUs
16.4400
Conversion factor
$33.4009
Medicare rate
$549.11
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 25624
25624 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 25624
Scaphoid fracture care
| 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 · 25624
Scaphoid fracture care
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
25624 without 50 · national office
$549.11
Scaphoid fracture care
25624-50 · Bilateral: 150%
$823.67
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).
25624 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 25622Scaphoid fracture care
- Both describe closed scaphoid fracture treatment. Choose 25624 when manipulation is performed; choose 25622 when treatment is without manipulation.
- 25628Scaphoid fixation
- 25628 is for open scaphoid fracture treatment with internal fixation; 25624 is closed treatment with manipulation.
- 25635Carpal fracture treatment
- 25635 describes closed treatment with manipulation of a carpal fracture other than the scaphoid. For a scaphoid fracture, use 25624.
25624 billing questions
When should I choose 25624 instead of 25622?
Use 25624 when the clinician manipulates the scaphoid fracture during closed treatment. Code 25622 describes closed scaphoid fracture treatment without manipulation.
How does 25624 differ from 25628?
25624 is closed treatment with manipulation. Use 25628 when the scaphoid fracture is treated openly with internal fixation.
What documentation supports 25624?
Document the scaphoid fracture, the closed reduction or manipulation performed, and the treatment plan, including immobilization when used. The record should distinguish manipulation from immobilization alone.
Are routine follow-up visits included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
How is bilateral treatment reported?
When the service is performed bilaterally, CMS pays 150% with modifier 50. For multiple procedures in the same session, the highest-valued procedure is paid in full and others are subject to the 50% reduction.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are not permitted for this code.
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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