CPT 25440 Scaphoid Nonunion Repair Reimbursement | OpenPayer

Summary & Overview

CPT 25440: Scaphoid Nonunion Repair with Possible Styloidectomy and Graft

CPT code 25440 covers surgical repair of a nonhealing (nonunion) fracture of the scaphoid carpal bone, and may include radial styloid excision and bone grafting when indicated. The code documents definitive operative management intended to promote scaphoid union and restore wrist function following failed conservative treatment or chronic fracture. Nationally, billing for scaphoid nonunion repair is clinically significant because scaphoid fractures have a high risk of nonunion and long-term morbidity if not addressed, making accurate coding essential for care delivery, resource planning, and quality measurement.

This analysis covers common commercial and public payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the code, typical sites of service and service type, as well as expected billing considerations such as commonly reported modifiers and related billing elements. The publication also summarizes benchmarking elements and policy-relevant points that affect coverage and reimbursement for operative scaphoid nonunion management, and outlines where to look for payer-specific edits and preauthorization requirements. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare25440CPThand-surgeryorthopedicsscaphoid-nonunionbone-graftstyloidectomysurgical-procedure

Billing Code Overview

CPT code 25440 describes surgical repair of a nonhealing (persistent) fracture of the scaphoid carpal bone in the wrist. The procedure can include excision of the radial styloid and application of a bone graft when necessary. This typically involves open operative management of the scaphoid to achieve union and restore wrist stability and function.

Service type: Surgical repair of scaphoid nonunion, possibly including styloidectomy and bone grafting
Typical site of service: Ambulatory surgical center or hospital operating room

Clinical & Coding Specifications

Clinical Context

A 28-year-old right-hand–dominant male motorcycle rider presents 6 months after a wrist injury with persistent radial-sided wrist pain, tenderness in the anatomical snuffbox, and limited wrist motion. Imaging (plain radiographs and CT) demonstrates a nonunion of a displaced scaphoid waist fracture. After failed conservative management including immobilization and persistent nonhealing demonstrated on serial imaging, the orthopedic hand surgeon schedules operative intervention: open repair of the nonhealing scaphoid fracture with excision of a symptomatic radial styloid if present and application of autologous or corticocancellous bone graft to promote union. The procedure is performed in an ambulatory surgical center under regional block with monitored anesthesia care. Postoperative workflow includes immobilization in a thumb spica cast or splint, routine wound checks, serial radiographs at 6 and 12 weeks to confirm healing, and hand therapy to restore range of motion and strength once radiographic union is achieved.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician's professional service when technical component billed separately.
`50`

CPT 25415: Osteotomy and Fixation for Radius and Ulna Nonunion/Malunion

CPT-25332-WRIST-DISTAL-RADIUS-CARPAL-EXCISION-FIXATION

CPT 25332: Excision of Distal Radius and Carpal Bone with Stabilization

CPT-25430-VASCULARIZED-BONE-GRAFT-CARPAL-REVASCULARIZATION

CPT 25430: Vascularized Bone Graft for Carpal Revascularization

CPT-25443-SCAPHOID-PROSTHESIS-IMPLANTATION-WRIST

CPT 25443: Scaphoid Prosthesis Implantation, Wrist

CPT-25405-CORRECTIVE-OSTEOTOMY-RADIUS-ULNA-AUTOGRAFT

CPT 25405: Corrective Osteotomy of Radius or Ulna with Autograft

CPT-25447-INTERPOSITION-ARTHROPLASTY-INTERCARPAL-CARPOMETACARPAL-JOINT

CPT 25447: Interposition Arthroplasty of Intercarpal or Carpometacarpal Joint

CPT-25441-DISTAL-RADIUS-RESECTION-WITH-IMPLANT

CPT 25441: Distal Radius Resection with Prosthetic Replacement

CPT-25272-DELAYED-EXTENSOR-TENDON-REPAIR-FOREARM-WRIST

CPT 25272: Delayed Extensor Tendon or Muscle Repair, Forearm/Wrist

CPT-25390-RADIUS-ULNA-SHORTENING-OSTEOTOMY

CPT 25390: Radius or Ulna Shortening Osteotomy

CPT-25270-EXTENSOR-TENDON-REPAIR-FOREARM-WRIST-ACUTE

CPT 25270: Repair of Extensor Tendon or Muscle, Forearm or Wrist

Showing 1–10 of 53

Taxonomy Code	Specialty	Notes
207X00000X	Orthopedic Surgery	Common specialty performing scaphoid nonunion repair.
207XS0112X	Hand Surgery	Common specialty focusing on complex wrist and hand procedures.
2080S0002X	Plastic Surgery	Performs hand reconstruction and bone grafting in some centers.
163W00000X	Physical Medicine & Rehabilitation	Provides postoperative therapy and nonoperative management.
363A00000X	Anesthesiology	Provides regional block and perioperative anesthesia care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M84.352A`	Pathologic fracture, scaphoid bone, right wrist, initial encounter for fracture	Represents a scaphoid fracture; used when documenting fracture nonunion with later modifier characters as appropriate.
`M84.351A`	Pathologic fracture, scaphoid bone, left wrist, initial encounter for fracture	As above for the left wrist.
`S62.01X9A`	Unspecified fracture of scaphoid bone, unspecified wrist, initial encounter for closed fracture	Commonly used for acute scaphoid fractures; later encounters specify nonunion or delayed healing.
`M84.39`	Other specified disorders of bone density and structure	May be relevant when bone quality contributes to nonunion risk.
`M84.81`	Nonunion of fracture, not elsewhere classified	Used to indicate nonunion when a more specific nonunion code is not available or in combination with scaphoid-specific codes.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`25440`	Repair of nonhealing scaphoid fracture; may include excision of radial styloid and bone graft	Primary procedure described.
`25600`	Open treatment of distal radial fracture (e.g., internal fixation)	May be performed if concomitant radius pathology requires fixation or radial styloid excision extends into distal radius work.
`20930`	Allograft, morselized, or placement of osteopromotive material, for spine or other; first graft	May be reported if bone graft substitutes or allograft material are implanted during scaphoid nonunion repair.
`20936`	Autograft for spine or other; larger volume with microvascular anastomosis — commonly used for vascularized bone grafts	Used when a vascularized bone graft (e.g., vascularized distal radius graft) is harvested and transferred for scaphoid reconstruction.
`20680`	Removal of implant; deep (e.g., buried screw)	May be used subsequently if previous hardware is removed during the index procedure or in a later stage.
`29848`	Arthroscopy, wrist, surgical; synovectomy, limited	May be performed arthroscopically in evaluation or concurrent treatment of intra-articular pathology of the wrist during scaphoid procedures.

OpenPayer