Billing code 25448: Wrist arthroplastyMedicare rate & RVUs in Washington
Reports interposition arthroplasty with suspension for an intercarpal or carpometacarpal joint, commonly used to reconstruct the thumb base after painful arthritis.
CMS doesn’t publish an office rate for 25448 in Washington.
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 25448 covers
This procedure reconstructs an intercarpal or carpometacarpal joint using interposition and suspension techniques. A common setting is surgery for painful thumb carpometacarpal, or basal-joint, arthritis, where the surgeon removes the trapezium and stabilizes the first metacarpal. An orthopedic or hand surgeon typically performs the operation in a hospital or ambulatory surgery center. The suspension component distinguishes this service from interposition arthroplasty without that component.
Report the code when the operative work includes the specified joint reconstruction with suspension; the operative report should identify the treated joint and describe the reconstruction performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 bilateral procedures are paid at 150%. Assistant-at-surgery services may be paid; co-surgeons are paid only with supporting documentation, and team surgery is 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 25448 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $825.86 |
| Seattle (King Cnty) | Unavailable | $906.90 |
How the 25448 rate is calculated
Each of 25448’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 · 25448
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 11.55Practice expense 10.78Malpractice 2.20
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 25448
25448 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 25448
Wrist arthroplasty
| 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) | 1 | Permitted with supporting documentation. |
| 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 · 25448
Wrist arthroplasty
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
25448 without 50 · national facility
$819.32
Wrist arthroplasty
25448-50 · Bilateral: 150%
$1,228.98
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).
25448 compared with similar codes
Compare codes
25448 vs 25447 vs 25445 vs 25449: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 25447Interposition arthroplasty
- Use 25448 when the interposition reconstruction includes suspension. Code 25447 describes the related interposition arthroplasty without suspension.
- 25445Trapezium arthroplasty
- This code describes prosthetic replacement of the trapezium, rather than interposition arthroplasty with suspension.
- 25449Wrist revision
- This code is for revision of a wrist arthroplasty, not primary intercarpal or carpometacarpal reconstruction with suspension.
25448 billing questions
How does 25448 differ from 25447?
25448 describes interposition arthroplasty with suspension. Use 25447 for the related interposition arthroplasty without the suspension component.
What documentation supports reporting 25448?
The operative report should identify the intercarpal or carpometacarpal joint treated and describe both the interposition reconstruction and suspension work.
Does the 90-day global period include routine postoperative care?
Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery services may be paid. Co-surgeons are paid only with supporting documentation.
How is bilateral 25448 handled?
For a bilateral procedure, report modifier 50; CMS pays the bilateral procedure at 150%.
Can 25448 be reported with another procedure performed in the same session?
When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction.
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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