CPT 25442 Distal Ulna Resection Reimbursement | OpenPayer

Summary & Overview

CPT 25442: Distal Ulna Resection with Implant Replacement

CPT code 25442 represents surgical resection of the distal ulna with replacement by an artificial implant, a specialized orthopedic procedure used to relieve ulnar-sided wrist pain and restore joint function. Nationally, this code matters for surgical practices, hospital billing units, and payers because it involves implantable device charges and operative complexity that affect coverage, prior authorization, and reimbursement rules. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the clinical context for use of CPT code 25442, typical sites of service, and the payer landscape relevant to this procedure. The publication provides benchmarks and policy-relevant points such as common billing considerations for implant surgeries, expected settings for service delivery, and areas where coverage policies or preauthorization requirements commonly apply. The summary also outlines what to expect in claims processing for procedures involving implants and highlights where payers and providers often need alignment on coding, documentation, and device-related charge reporting. Data not available in the input for specific diagnosis pairings, associated taxonomies, or payer-specific payment rates.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 25442orthopedic surgerywrist surgeryulnar resectionimplant replacementambulatory surgeryhospital surgerysurgical procedure coding

Billing Code Overview

CPT code 25442 describes a surgical procedure in which the provider removes the distal (lower) end of the ulna and replaces it with an artificial implant. This procedure is a form of wrist/ulnar joint reconstruction intended to address pain, instability, or degenerative disease affecting the ulnar side of the wrist.

Service type: Surgical/orthopedic reconstructive procedure
Typical site of service: Hospital operating room or ambulatory surgery center

Clinical & Coding Specifications

Clinical Context

A typical patient is a 55-year-old right-handed manual laborer who presents with chronic ulnar-sided wrist pain, decreased grip strength, and limited forearm rotation following degenerative changes or post-traumatic distal radioulnar joint (DRUJ) arthrosis. Conservative care including activity modification, splinting, nonsteroidal anti-inflammatory drugs, and corticosteroid injection has failed. Imaging (radiographs and CT or MRI) confirms advanced degenerative changes of the distal ulna and DRUJ with joint incongruity. The surgical workflow includes preoperative evaluation and consent, regional or general anesthesia, exposure of the distal ulna, resection of the distal ulnar head, preparation of the ulnar stump and/or radioulnar articulation, placement of an appropriate ulnar head implant (total ulnar head arthroplasty or hemiarthroplasty), intraoperative fluoroscopic confirmation of implant position, layered closure, and postoperative immobilization followed by hand therapy for range of motion and strengthening. Typical site of service is an ambulatory surgery center or hospital outpatient surgical department. Perioperative documentation includes indication, informed consent, implant device details (manufacturer, model, size), anesthesia record, procedure note documenting resection and implant placement, and postop instructions including activity restrictions and follow-up schedule.

Coding Specifications

Modifier	Description	When to Use
`00`	Standard - no modifier	Use when no special circumstances apply and the claim is submitted without additional modifier.

CPT 25275: Extensor Tendon Repair of Forearm/Wrist with Tissue Graft

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

CPT 25441: Distal Radius Resection with Prosthetic Replacement

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

CPT 25447: Interposition Arthroplasty of Intercarpal or Carpometacarpal Joint

CPT-25370-RADIUS-ULNA-OSTEOTOMY-INTRAMEDULLARY-FIXATION

CPT 25370: Osteotomy of Radius or Ulna Shaft with Intramedullary Rod

CPT-25492-FOREARM-RADIUS-ULNA-RECONSTRUCTION-INTERNAL-FIXATION

CPT 25492: Forearm Radius and Ulna Reconstruction with Internal Fixation

CPT-25315-FLEXOR-TENDON-ORIGIN-RELEASE-HAND-WRIST

CPT 25315: Flexor Tendon Origin Release for Hand/Wrist Deformity

CPT-25316-TENDON-RELEASE-AND-TRANSFER-FOREARM-WRIST-FOR-HAND-DEFORMITY

CPT 25316: Tendon Release and Tendon Transfer for Hand/Wrist Reconstruction

CPT-25337-DISTAL-RADIOULNAR-JOINT-STABILIZATION-TENDON-REPAIR

CPT 25337: Distal Radioulnar Joint Stabilization, Tendon-Based Reconstruction

CPT-25449-WRIST-PROSTHESIS-REVISION-REMOVAL-REPLACEMENT

CPT 25449: Revision or Removal/Replacement of Wrist Prosthesis

CPT-25280-FOREARM-WRIST-TENDON-LENGTH-ADJUSTMENT-REPAIR

CPT 25280: Tendon Length Adjustment/Repair, Forearm or Wrist

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Taxonomy Code	Specialty	Notes
`207RE0100X`	Orthopedic Surgery	Primary specialty performing distal ulna resection and implant arthroplasty.
`207N00000X`	Hand Surgery	Fellowship-trained hand surgeons commonly perform this procedure.
`207Q00000X`	Plastic Surgery	Plastic surgeons with hand specialty perform complex reconstructive wrist/forearm procedures.
`2086S0122X`	Sports Medicine (Orthopedics)	Shoulder/elbow/hand specialists managing complex wrist arthroplasty in active patients.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M19.239`	Primary osteoarthritis, unspecified wrist	Degenerative arthrosis of the distal radioulnar joint that can necessitate distal ulnar resection and prosthetic replacement.
`M18.9`	Osteoarthritis of first carpometacarpal joint, unspecified	Frequently coexists with wrist degenerative disease and may be part of a broader hand/wrist osteoarthritis diagnosis; relevant for comprehensive surgical planning.
`M21.61`	Other acquired deformity, right wrist	Post-traumatic deformity contributing to DRUJ dysfunction and pain prompting surgical correction.
`S63.201A`	Subluxation of unspecified wrist, initial encounter	Acute or chronic instability of the distal radioulnar joint that may be treated with resection and implant when conservative measures fail.
`M65.821`	Other synovitis and tenosynovitis, right wrist	Chronic inflammatory conditions around the DRUJ that can accelerate joint degeneration and lead to surgical intervention.
`M25.631`	Pain in right wrist	Symptom code commonly used as a supporting diagnosis for surgical indications when specific joint pathology is documented.
`M24.239`	Other specific joint derangements, wrist	Mechanical derangement of the DRUJ or distal ulna contributing to pain and dysfunction addressed by resection and prosthesis.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`25442`	Resection of distal end of ulna with insertion of prosthesis (implant)	Primary procedure: removal of the distal ulna and replacement with an artificial implant.
`25440`	Resection of distal end of ulna (Darrach procedure) without prosthesis	Alternative or related procedure when resection is performed without implant placement. May be performed in different clinical contexts or if implantation is not feasible.
`25446`	Reconstruction, distal ulna; with soft tissue stabilization or stabilization procedure	Performed when additional soft tissue stabilization or reconstruction of the DRUJ is required in conjunction with resection/implant.
`20680`	Removal of implant; deep (e.g., buried wires, pins)	Used if postoperative complication necessitates removal of a deep implant related to the ulnar prosthesis.
`64999`	Unlisted procedure, nervous system (for carpal/ulnar neuropathy procedures)	May be used when a concurrent atypical nerve procedure is performed that has no specific CPT code; documentation must justify unlisted code use.
`29848`	Wrist arthroscopy, surgical; distal radioulnar joint (DRUJ)	Performed adjunctively for diagnostic assessment or minimally invasive debridement prior to or in conjunction with open ulnar head procedures.

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