CPT 25210 Excision of Carpal Bone — Reimbursement | OpenPayer

Summary & Overview

CPT 25210: Excision of Single Carpal Bone (Partial Carpectomy)

CPT code 25210 represents the surgical excision of any one carpal bone in the wrist (partial carpectomy). This operative procedure is used to treat severe degenerative changes, fractures, chronic pain, or instability localized to a single carpal bone and has implications for functional outcomes and post‑operative rehabilitation needs across patient populations. Nationally, the code is relevant for surgical case-mix, utilization tracking, and payment policy discussions for hand and wrist procedures.

Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on clinical context and typical sites of service, as well as what to expect in claims and coding practice for this procedure. The publication outlines benchmarks for utilization and payment patterns where available, highlights recent policy and coding considerations affecting coverage, and situates the procedure within broader orthopedic and hand surgery service lines. The aim is to inform billing professionals, policy analysts, and clinical administrators about the code’s clinical meaning, payer relevance, and areas where payers commonly focus review or medical necessity determinations.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 25210hand surgerycarpectomywrist surgeryorthopedic proceduresurgical codingoperative procedurepartial carpectomyambulatory surgery

Billing Code Overview

CPT code 25210 describes the surgical removal of any one of the eight carpal bones in the wrist. This procedure is a form of partial carpectomy performed to address degenerative disease, traumatic injury, chronic pain, or structural abnormalities affecting an individual carpal bone.

Service type: Surgical procedure (orthopedic hand/wrist surgery)
Typical site of service: Hospital operating room or ambulatory surgery center

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 58-year-old right-hand dominant patient presents with chronic wrist pain, limited range of motion, and persistent crepitus after previous distal radius fracture fixation and developing post-traumatic carpal instability and degenerative arthritis. Conservative care including splinting, anti-inflammatory medication, steroid injections, and hand therapy failed to relieve symptoms. Imaging (plain radiographs, CT) demonstrates advanced degenerative change isolated to one carpal bone (for example, the scaphoid or lunate) with fragmentation and collapse. The orthopedic hand surgeon schedules a single carpal bone excision — removal of the affected carpal bone — performed in an ambulatory surgery center or hospital outpatient department under regional block with monitored anesthesia care or general anesthesia. The clinical workflow includes preoperative evaluation and consent, imaging review, regional or general anesthesia, surgical excision of the identified carpal bone, intraoperative hemostasis and possible limited soft-tissue reconstruction, postoperative immobilization in a splint, discharge with analgesia and hand therapy referral, and routine follow-up visits for wound check and rehabilitation.

Coding Specifications

Modifier	Description	When to Use
`51`	Multiple Procedures	When `25210` is billed along with other distinct procedures in the same session performed by the same surgeon.

CPT 25150: Focal Bone Excision (Saucerization)

25111-EXCISION-OF-GANGLION-WRIST-DORSAL-OR

CPT 25111: Excision of Wrist Ganglion (Dorsal or Volar)

CPT-25130-WRIST-CARPAL-BONE-EXCISION-BENIGN-LESION

CPT 25130: Excision of Benign Lesion, Exposure of Carpal Bones

CPT-25085-WRIST-JOINT-CAPSULOTOMY-RELEASE-CONTRACTURE

CPT 25085: Wrist Joint Capsule Release (Capsulotomy)

CPT-25100-WRIST-JOINT-BIOPSY-INCISION

CPT 25100: Incision and Biopsy of Wrist Joint

CPT-25145-FOREARM-WRIST-SEQUESTRECTOMY-REMOVAL-DEAD-BONE

CPT 25145: Removal of Separated Dead Bone, Forearm or Wrist

CPT-25240-DISTAL-ULNA-EXCISION-WRIST-ARTHRITIS-MALUNION

CPT 25240: Excision of Distal Ulna for Wrist Arthritis or Malunion

CPT-25065-FOREARM-WRIST-SUPERFICIAL-SOFT-TISSUE-EXCISIONAL-BIOPSY

CPT 25065: Excisional Biopsy of Superficial Soft Tissue, Forearm/Wrist

CPT-25078-FOREARM-WRIST-SOFT-TISSUE-TUMOR-WIDE-EXCISION

CPT 25078: Excision of Forearm/Wrist Soft Tissue Tumor with Wide Excision

CPT-25170-FOREARM-BONE-TUMOR-EXCISION-RADIUS-ULNA

CPT 25170: Excision of Tumor of Radius or Ulna

Showing 1–10 of 34

Taxonomy Code	Specialty	Notes
`208K00000X`	Orthopaedic Surgery	Hand and wrist surgeons who commonly perform carpal bone excision.
`207LH0000X`	Plastic Surgery	Hand surgeons within plastic surgery who perform complex wrist reconstructions and carpal excisions.
`208U00000X`	Surgery of the Hand	Providers specialized in hand surgery performing carpal bone procedures.
`207L00000X`	General Surgery	Occasionally involved in upper extremity procedures in certain settings.
`263SP0800X`	Anesthesiology	Providers who administer regional or general anesthesia for this procedure.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M19.231`	Primary osteoarthritis, right wrist	Degenerative arthritis isolated to a carpal bone leading to excision.
`M19.232`	Primary osteoarthritis, left wrist	Same as above for the left side.
`M24.231`	Disorder of ligament, right wrist	Post-traumatic instability that may necessitate carpal bone excision.
`M24.232`	Disorder of ligament, left wrist	Same as above for the left side.
`S62.01xA`	Fracture of scaphoid bone, initial encounter for closed fracture	Nonunion or degenerative collapse after scaphoid fracture can require excision.
`M89.021`	Aseptic necrosis of scaphoid, right wrist	Avascular necrosis leading to collapse and excision.
`M75.3`	Calcific tendinitis of shoulder (not directly related)	Data not applicable — excluded if strictly adhering to wrist-specific codes.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`20600`	Arthrocentesis, aspiration and/or injection; small joint or bursa (e.g., wrist)	May be performed preoperatively for diagnostic or therapeutic relief prior to definitive carpal bone excision.
`25320`	Capsulorrhaphy, wrist; stabilization procedures (distinct procedure)	Performed when additional wrist stabilization is required with or after carpal bone excision.
`25115`	Excision, carpal bone, any one (alternative codes historically listed)	Related excision codes; used when coding nuances require alternative specific excision coding.
`29848`	Arthroscopy, wrist, surgical; with synovectomy, debridement, and/or excision (if performed arthroscopically)	May be performed instead of or preceding an open carpal bone excision for diagnosis or limited debridement.
`99024`	Postoperative follow-up visit global period (general)	Used for routine postoperative evaluation during the global period (facility-dependent billing practices).

OpenPayer