Summary & Overview
CPT 25446: Wrist and Distal Forearm Prosthetic Reconstruction
CPT code 25446 represents an extensive reconstructive orthopedic procedure that replaces the radial head and portions of the carpus with prosthetic implants, accompanied by excision of the radial and ulnar heads and removal of selected carpal bones. Nationally, this code captures high-complexity wrist and distal forearm reconstructions that have implications for surgical resource use, device utilization, and postoperative rehabilitation planning. Key payers in typical coverage and payment analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the clinical scope and billing context of the procedure, common sites of service, and typical payer coverage landscape. The publication provides benchmarks for utilization and spending where available, summarizes relevant policy and coding considerations affecting authorization and claims adjudication, and situates the procedure within clinical care pathways for severe wrist and distal forearm pathology. Data not available in the input will be noted where applicable. The content is intended for a national audience of clinicians, coding professionals, and payer policy staff seeking a concise reference on CPT code 25446.
Billing Code Overview
CPT code 25446 describes a surgical procedure in which the provider performs replacement of the radial head and carpal bones with prosthetic components, including excision of the radial and ulnar heads and removal of all or some carpal bones. This operation is a complex reconstructive orthopedic procedure focused on the distal radius/ulna and wrist joint.
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Service type: Wrist and distal forearm reconstruction with prosthetic joint and carpal bone replacement
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Typical site of service: Inpatient or outpatient hospital surgical setting or ambulatory surgery center, depending on clinical complexity and perioperative needs
Clinical & Coding Specifications
Clinical Context
A typical patient is a 55–75-year-old adult with severe wrist arthritis or post-traumatic wrist destruction presenting with chronic wrist pain, instability, and loss of function. Conservative measures (oral analgesics, splinting, corticosteroid injections, and physical therapy) have failed. Imaging (radiographs, CT) demonstrates advanced degenerative changes of the distal radius, radial head involvement, and significant carpal bone collapse or sclerosis. The orthopedic hand surgeon evaluates the patient in an outpatient clinic, confirms indications for wrist salvage, and discusses options including total wrist arthroplasty with excision of the radial and ulnar heads and partial carpectomy with implantation of radial and carpal prostheses.
Preoperative workflow includes medical clearance, templating prosthesis size, and obtaining informed consent. On the day of service in an ambulatory surgery center or inpatient operating room, the patient undergoes general or regional anesthesia. The surgeon performs the procedure involving excision of the radial and ulnar heads as indicated, removal of selected carpal bones, and implantation of radial and carpal prosthetic components. Intraoperative fluoroscopy confirms alignment. Postoperative care includes immobilization, pain control, and early hand therapy; typical follow-up visits occur at 2 weeks, 6 weeks, 3 months, and as needed for rehabilitation and monitoring for prosthesis complications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
RT | Right side |