Billing code 25628: Scaphoid fixationMedicare rate & RVUs in Utah
Reports open operative treatment of a carpal scaphoid fracture when the surgeon stabilizes the fracture with internal fixation.
CMS doesn’t publish an office rate for 25628 in Utah.
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 25628 covers
An orthopedic or hand surgeon uses an open approach to expose and treat a fractured scaphoid, a carpal bone on the thumb side of the wrist. The surgeon restores fracture alignment as needed and stabilizes the bone with internal fixation, such as a screw. This treatment is commonly performed in an operating room for a displaced or unstable scaphoid fracture when operative fixation is selected.
Report 25628 when the operative record supports open treatment of the scaphoid fracture with internal fixation; closed management or treatment of a different carpal bone calls for a different code. Document the fracture site, operative approach, reduction or alignment work, and fixation performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and 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 services may be paid; 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.
25628 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $645.25 |
How the 25628 rate is calculated
Each of 25628’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 · 25628
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 9.43Practice expense 8.80Malpractice 1.80
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 25628
25628 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 25628
Scaphoid fixation
| 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) | 2 | Paid. |
| 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 · 25628
Scaphoid fixation
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
25628 without 50 · national facility
$669.02
Scaphoid fixation
25628-50 · Bilateral: 150%
$1,003.53
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).
25628 compared with similar codes
Compare codes
25628 vs 25622 vs 25624 vs 25440 vs 25645: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 25622Scaphoid fracture care
- 25622 is closed treatment of a scaphoid fracture without manipulation. Use 25628 when the surgeon opens the site and stabilizes the fracture with internal fixation.
- 25624Scaphoid fracture care
- 25624 is closed treatment of a scaphoid fracture with manipulation. It does not represent open fixation as reported with 25628.
- 25440Scaphoid repair
- 25440 addresses repair of an established scaphoid nonunion or malunion. 25628 describes open fixation of a scaphoid fracture, not reconstruction of a nonunion or malunion.
- 25645Carpal fracture repair
- 25645 is open treatment of a carpal fracture in a bone other than the scaphoid. 25628 is specific to the scaphoid.
25628 billing questions
When should 25628 be chosen over closed scaphoid fracture treatment?
Use 25628 when the surgeon treats the scaphoid fracture through an open approach and applies internal fixation. Closed treatment without manipulation or with manipulation is represented by 25622 or 25624, respectively.
Does 25628 describe fixation of any carpal bone?
No. It is specific to open treatment with internal fixation of a scaphoid fracture. Open treatment of a carpal fracture other than the scaphoid is represented by 25645.
What documentation supports reporting 25628?
The operative report should identify the scaphoid fracture and describe the open approach and internal fixation performed. Include the treatment details that distinguish the service from closed management or treatment of another carpal bone.
Are related postoperative visits included?
Yes. Medicare assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon be reported with 25628?
Assistant-at-surgery services may be paid. Co-surgeons and team surgery are not permitted under the supplied CMS rules for this code.
How does Medicare handle bilateral reporting and other procedures in the same session?
Bilateral reporting with modifier 50 is paid at 150%. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%.
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
Fee sheets
Put 25628 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →