Abstract
Background:
Total wrist arthrodesis is a well-established procedure providing pain relief and stability for patients with symptomatic radiocarpal arthritis refractory to nonoperative measures. Little research exists on reimbursement and utilization trends for this procedure. This study aimed to characterize Medicare reimbursement trends for total wrist arthrodesis, along with trends in Medicare utilization and comparison with Medicaid reimbursement.
Methods:
Medicare reimbursement for Current Procedural Terminology codes 25800, 25805, and 25810 were collected from the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule from 2000 to 2025. Rates were inflation-adjusted to 2025 dollars, and percentage changes were calculated. Medicare utilization trends from 2000 to 2022 were analyzed using CMS Part B data. Most recent Medicaid reimbursement was collected from online state fee schedules and compared with 2025 Medicare rates, with additional analyses of variability and adjustment for work Relative Value Units.
Results:
Inflation-adjusted Medicare reimbursement for total wrist arthrodesis decreased by 49.1% from 2000 to 2025 (P < .0001), averaging a 1.96% annual decline. Utilization trends remained stable, with wrist arthrodesis with iliac or other autograft (CPT 25810) being the most commonly billed procedure. Medicaid reimbursed 13.6% less than Medicare on average, with substantial state variability, ranging from 44.7% (New Hampshire) to 135.4% (Alaska) of Medicare reimbursement.
Conclusion:
Reimbursement for total wrist arthrodesis has declined significantly despite stable utilization in the Medicare population. Medicaid reimbursement is consistently lower and highly variable by state, potentially impacting access to care. Given the effectiveness of wrist arthrodesis, policymakers should advocate for equitable reimbursement for this procedure.
Keywords: wrist, anatomy, health policy, research and health outcomes, epidemiology, arthritis, diagnosis, surgery, specialty
Introduction
Total wrist arthrodesis is a well-established procedure that has been in practice since the early 1900s with several iterations of the procedure occurring over the last century. 1 This procedure provides satisfactory results for patients as it relieves pain and provides a stable wrist for grip at the expense of motion. 2 Its typical indications are for patients who have painful degenerative, inflammatory, postinfectious, or post-traumatic radiocarpal and midcarpal arthritis refractory to conservative measures. The outcomes of total wrist arthrodesis have been very successful with multiple studies illustrating that patients can return to the same level of preoperative employment activities after surgery, and even showing a significant number of patients having complete pain relief from this surgery.1,3
It can be postulated that patient improvements lead to decreases in medical resource utilization, as patients are less likely to need future outpatient treatments for pain, have fewer functional limitations, and are able to return to work. Given the mutual benefits to patients, surgeons, and insurance companies, it is thought that insurance companies should incentivize surgeons to perform total wrist arthrodesis when indicated. There exists some limited data on total wrist arthrodesis reimbursement from Medicare, including 2 studies on hand procedures that each included only one total wrist arthrodesis code.4,5 These studies, which analyzed data from 2002 to 2018 or 2000 to 2019, found a 30.6% and 33.9% decrease, respectively, in inflation-adjusted reimbursement for their included arthrodesis code. However, a comprehensive and dedicated analysis on total wrist arthrodesis codes does not exist. This study aims to evaluate Medicare reimbursement for total wrist arthrodesis over the past 25 years, along with Medicare utilization trends and Medicaid reimbursement comparisons.
Methods
Medicare Reimbursement Trends
This study did not collect or analyze any patient data and used publicly available de-identified data; thus, our Institutional Review Board considers this research exempt. Current Procedural Terminology (CPT) codes 25800 (wrist arthrodesis without graft), 25805 (wrist arthrodesis with sliding graft), and 25810 (wrist arthrodesis with iliac or other autograft) were selected for analysis. Rates were gathered from the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule Look-Up Tool for years 2000 to 2025. 6 Medicare rates vary slightly based on the geographic location in which the service occurs, which is determined by Medicare Administrative Contractor (MAC) localities that roughly approximate state lines. 7 To represent the entirety of Medicare reimbursement, all MAC localities were averaged together into one rate for each CPT code, by year. Previous years’ rates were then adjusted using an inflation calculator, based on inflation information from the US Census Bureau, so that all rates were represented in 2025 dollars. 8 Both unadjusted and inflation-adjusted rates were plotted on a line graph. Total percentage change and percentage change per year were calculated for each. A 2-tailed t test comparison of means was performed comparing inflation-adjusted 2000 to 2025 average Medicare reimbursement for each of the 3 CPT codes.
Medicare Utilization Trends
To understand Medicare utilization trends for each procedure, the number of times each CPT code was billed to Medicare was obtained from the CMS Medicare Utilization for Part B file for all available years (2000-2022). 9 These data were plotted onto a line graph with total percentage change and percentage change per year calculated for all CPT codes.
Medicare versus Medicaid
Medicare rates for 2025 were collected for each state along with corresponding work Relative Value Units (wRVUs), a measure of the perceived effort required for a surgeon to perform a task, which factors into reimbursement (Table 1). While most states are represented by a single MAC locality, in large states where multiple localities exist, the option “rest of state” was selected. The most recent Medicaid rates were obtained from online state Medicaid fee schedules. Tennessee was excluded as its Medicaid program does not use a fee-for-service model. No modifier codes were included in the data selection. Medicare and Medicaid rates were compared using state and national averages and dollar differences. Adjustment for wRVUs was made to equalize differences in effort required by procedure code. To assess the variability within each insurance type, the coefficient of variation (CoV) was calculated by dividing the standard deviation by the mean. Data with a CoV close to 0 indicate low variability, whereas values further from 0 represent greater variability.
Table 1.
Included Wrist Arthrodesis Codes With Corresponding wRVUs.
| CPT code | Description | wRVUs |
|---|---|---|
| 25800 | WRIST ARTHRODESIS, WITHOUT GRAFT | 10.07 |
| 25805 | WRIST ARTHRODESIS, WITH SLIDING GRAFT | 11.73 |
| 25810 | WRIST ARTHRODESIS, WITH ILIAC OR OTHER AUTOGRAFT | 11.95 |
Note. wRVUs = work Relative Value Units; CPT = Current Procedural Terminology.
Results
Medicare Reimbursement Trends
Cumulative inflation from 2000 to 2025 totaled 84.5%, averaging to 3.38% per year. Table 2 lists the changes in Medicare reimbursement by year for each CPT code, with and without inflation adjustment. Altogether, wrist arthrodesis reimbursement decreased by 6.1% more than 25 years, or a 49.1% difference when adjusted for inflation (Table 3). By year, this represents a 0.24% change, or 1.96% with inflation adjustment. Figure 1 visualizes these inflation-adjusted changes by year for all 3 codes. All 3 CPT codes were found to have significantly decreased in reimbursement from 2000 to 2025 when adjusted for inflation (P < .0001).
Table 2.
Average Medicare Rates by Year With and Without Inflation Adjustment, 2000 to 2025.
| Year | Cumulative inflation, % | CPT code | |||||
|---|---|---|---|---|---|---|---|
| 25800 | Adjusted 25800 | 25805 | Adjusted 25805 | 25810 | Adjusted 25810 | ||
| 2000 | 84.5 | $779.78 | $1438.69 | $893.98 | $1649.39 | $835.96 | $1542.35 |
| 2001 | 79.5 | $819.61 | $1471.20 | $929.74 | $1668.88 | $875.68 | $1571.85 |
| 2002 | 76.6 | $792.60 | $1399.73 | $881.55 | $1556.82 | $840.96 | $1485.14 |
| 2003 | 72.6 | $807.30 | $1393.40 | $903.24 | $1558.99 | $854.96 | $1475.66 |
| 2004 | 68.2 | $770.73 | $1296.37 | $880.15 | $1480.41 | $833.50 | $1401.95 |
| 2005 | 62.7 | $781.71 | $1271.84 | $893.29 | $1453.38 | $847.37 | $1378.67 |
| 2006 | 57.6 | $780.40 | $1229.91 | $891.09 | $1404.36 | $845.77 | $1332.93 |
| 2007 | 53.2 | $730.57 | $1119.23 | $837.82 | $1283.54 | $832.23 | $1274.98 |
| 2008 | 47.5 | $697.42 | $1028.69 | $800.56 | $1180.83 | $801.88 | $1182.77 |
| 2009 | 48.1 | $688.76 | $1020.05 | $794.01 | $1175.93 | $800.41 | $1185.41 |
| 2010 | 45.7 | $705.17 | $1027.43 | $815.76 | $1188.56 | $828.62 | $1207.30 |
| 2011 | 41.2 | $738.95 | $1043.40 | $854.07 | $1205.95 | $871.95 | $1231.19 |
| 2012 | 38.4 | $739.13 | $1022.96 | $851.76 | $1178.84 | $876.18 | $1212.63 |
| 2013 | 36.4 | $742.96 | $1013.40 | $857.62 | $1169.79 | $880.64 | $1201.19 |
| 2014 | 34.2 | $752.39 | $1009.71 | $869.02 | $1166.22 | $892.51 | $1197.75 |
| 2015 | 34 | $758.34 | $1016.18 | $878.85 | $1177.66 | $898.67 | $1204.22 |
| 2016 | 32.4 | $759.36 | $1005.39 | $877.69 | $1162.06 | $900.25 | $1191.93 |
| 2017 | 29.6 | $764.70 | $991.05 | $882.14 | $1143.25 | $907.56 | $1176.20 |
| 2018 | 26.5 | $769.48 | $973.39 | $886.73 | $1121.71 | $912.11 | $1153.82 |
| 2019 | 24.3 | $768.95 | $955.80 | $890.65 | $1107.08 | $913.13 | $1135.02 |
| 2020 | 22.7 | $773.60 | $949.21 | $894.85 | $1097.98 | $916.17 | $1124.14 |
| 2021 | 17.2 | $767.58 | $899.60 | $887.26 | $1039.87 | $906.02 | $1061.86 |
| 2022 | 8.5 | $766.22 | $831.35 | $887.04 | $962.44 | $903.34 | $980.12 |
| 2023 | 4.3 | $763.23 | $796.05 | $880.73 | $918.60 | $901.97 | $940.75 |
| 2024 | 1.3 | $740.29 | $749.91 | $856.22 | $867.35 | $877.09 | $888.49 |
| 2025 | $739.40 | $739.40 | $853.03 | $853.03 | $876.34 | $876.34 | |
Note. CPT = Current Procedural Terminology.
Table 3.
Wrist Arthrodesis Reimbursement by CPT Code From 2000 to 2025, With and Without Adjustment for Inflation.
| CPT code | Unadjusted total change, % | Unadjusted change per year, % | Adjusted total change, % | P value for adjusted 2000 vs 2025 rates | Adjusted change per year, % |
|---|---|---|---|---|---|
| 25800 | −9.46 | −0.38 | −50.93 | <.0001 | −2.04 |
| 25805 | −8.86 | −0.35 | −50.60 | <.0001 | −2.02 |
| 25810 | 0.10 | 0.00 | −45.74 | <.0001 | −1.83 |
| Average | –6.06 | –0.24 | –49.09 | <.0001 | –1.96 |
Note. CPT = Current Procedural Terminology.
Figure 1.
Trends in Medicare reimbursement for the 3 included wrist arthrodesis procedure codes, adjusted for inflation and reported in 2025 dollars.
Medicare Utilization Trends
Wrist arthrodesis with iliac or other autograft (CPT 25810) was consistently the most frequently billed code to Medicare, whereas wrist arthrodesis with sliding graft (CPT 25805) has remained infrequently-utilized, with many years failing to reach 100 claims. Wrist arthrodesis without graft (25800) demonstrated a 35.4% growth in utilization from 2000 to 2022, though its utilization has declined from the late 2010s. Despite year-to-year fluctuations, the utilization for each code remains fairly consistent (Figure 2).
Figure 2.
Trends in Medicare utilization for the 3 included wrist arthrodesis procedure codes from 2000 to 2022. This reflects the number of times each procedure code was billed to Medicare each year.
Medicare versus Medicaid
Nationally, Medicaid reimbursement was 13.6% less than Medicare. The average dollar difference was $99.85 less for Medicaid compared with Medicare, which amounted to $8.86 per wRVU. Wrist arthrodesis without graft (CPT 25800) demonstrated the lowest dollar difference between insurance types ($86.40 less for Medicaid), whereas wrist arthrodesis with iliac or other autograft (CPT 25810) demonstrated the greatest difference ($99.85 less for Medicaid). The CoV for Medicare procedures was 0.06 for all codes, reflecting low and consistent variation between states. The CoV for Medicaid averaged 0.25, corresponding to much greater variability, indicating that 1 standard deviation is equivalent to a quarter of total average reimbursement (Table 4).
Table 4.
National Average Medicare and Medicaid Reimbursement With Dollar Differences (Coefficient of Variation in Parentheses).
| CPT code | Medicaid reimbursement | Medicare reimbursement | Dollar difference | Dollar difference per wRVU |
|---|---|---|---|---|
| 25800 | $619.20 (0.25) | $706.01 (0.06) | −$86.40 | −$8.58 |
| 25805 | $710.39 (0.26) | $814.79 (0.06) | −$104.40 | −$8.90 |
| 25810 | $728.07 (0.25) | $836.81 (0.06) | −$108.75 | −$9.10 |
| Average | $686.02 (0.25) | $785.87 (0.06) | −$99.85 | −$8.86 |
Note. CPT = Current Procedural Terminology.
By state, Medicaid reimbursement ranged from 44.7% (New Hampshire) to 135.4% (Alaska) of Medicare. Twelve total state Medicaid programs reimbursed for wrist arthrodesis codes at a higher rate than Medicare. Following New Hampshire, the 4 states with the lowest reimbursement percentage were New Jersey (47.6%), Rhode Island (51.4%), Connecticut (57.4%), and Washington (58.1%) (Figure 3).
Figure 3.
Heatmap of the United States based on the ratio of Medicaid to Medicare reimbursement for the 3 combined total wrist arthrodesis codes.
Note. States with reimbursement ratios less than 1 appear red, whereas states with ratios greater than 1 appear blue. Tennessee was not included in this figure as its state does not use a fee-for-service Medicaid reimbursement system.
Discussion
Medicare reimbursement for all total wrist arthrodesis codes has decreased by more than 49% from 2000 to 2025 when adjusted for inflation. Utilization in the Medicare population has remained relatively stable from 2000 to 2022 for all 3 arthrodesis codes. Wrist arthrodesis with iliac or other autograft (CPT 25810) remains the most used code, and it also reimburses at a higher rate than other codes. Comparing the most recent Medicaid and Medicare rates, Medicaid reimburses 13.6% less. There is wide variability between state Medicaid rates, as average rates range from 44.7% to 135.4% of Medicare.
Medicare reimbursement has been declining steadily for more than 2 decades, which is mostly attributable to changes in rates associated with the Balanced Budget Act of 1997. 10 Studies in orthopedic subspecialties have noted between a 23% and 37% decrease in rates when adjusted for inflation.11-15 The further decrease seen in our study is most likely due to increased inflation since 2020, particularly following the COVID-19 pandemic. 16 Thus, it can be reasonably expected that procedure codes in many other subspecialties of orthopedic surgery share similar reimbursement decreases now since 2000.
Wrist arthrodesis with iliac or other autograft (CPT 25810) was consistently the highest used code in the Medicare population. The use of a graft may depend on the quality and quantity of remaining bone available, making graft utilization more desirable for large defects, as is seen with tumor resection or failed arthroplasty. 17 Sliding grafts (CPT 25805), usually taken from the distal radius as described by Sorial et al, 18 appear to be very uncommonly used compared with iliac crest or other autografts (25810). These autografts are likely favored for their osteogenic, osteoinductive, and osteoconductive properties as well as the ability to obtain adequate amounts necessary in patients undergoing arthrodesis with substantial bone loss, such as from prior trauma or subchondral cysts. 19 Sliding grafts may be preferred in select institutions, with proponents advocating for the decreased morbidity associated with not harvesting an autograft, but these may not be sufficient to address bone voids, which are often in the distal radius itself.5,20,21 Arthrodesis without graft (CPT 25800) may be suitable without large bony defects and was consistently the second most commonly performed total wrist arthrodesis subtype in the Medicare population.
Substantial overlap exists between the indications for total wrist arthrodesis and total wrist arthroplasty. Arthrodesis provides no limitation on weight-bearing and no concern regarding longevity, whereas arthroplasty may be suitable in patients who prioritize preservation of motion. Reports using data from the National Inpatient Sample have found a decrease in utilization of total wrist arthroplasty over the past several decades, perhaps due to historically higher complication rates and withdrawal of several prostheses from the market, whereas the utilization of wrist arthrodesis has remained relatively stable.22-24 The utilization of total wrist arthrodesis in the Medicare population in our study supports these prior findings. That total wrist arthrodesis has not seen a greater increase in utilization in the context of decreasing utilization of wrist arthroplasty may be a success of modern medical therapies for degenerative wrist conditions, such as rheumatoid arthritis, decreasing the need for wrist surgery. 25
Our findings that Medicaid reimburses less than Medicare is supported by a previous analysis on Medicaid reimbursement for several hand procedures. 26 Low Medicaid reimbursement, which is highly variable across states, may have negative impacts on access to care for Medicaid beneficiaries, as surgeons may simply refuse to accept Medicaid. Prior studies have suggested that lower socioeconomic class or Medicaid insurance may be associated with worsened disease burden of rheumatoid arthritis or other orthopedic conditions.27,28 Extrapolating these data to degenerative wrist conditions, it is likely that Medicaid beneficiaries have worsened disease burden, but could be limited in their surgical treatment options, especially if they live in a state with particularly low Medicaid reimbursement.
There are several limitations of our study. We collected Medicare and Medicaid reimbursement rates from online fee schedules, but we are unable to account for factors such as modifier codes or the location in which the service takes place, which can impact overall reimbursement. Our study is useful for surgeons under a fee-for-service model; however, it will be less applicable to those who are reimbursed a set rate for the number of Relative Value Units they generate. While approximately 19% of American citizens are covered by Medicare and 19% by Medicaid, 29 the majority remain covered by private insurance plans, which are not included in this study. Finally, whereas CMS records allowed us to trend reimbursement over time for Medicare reimbursement, many states do not keep archived records on past Medicaid rates, and thus a trend in Medicaid reimbursement was not performed.
Conclusion
Medicare reimbursement for total wrist arthrodesis has decreased significantly over the past 25 years, with consistent utilization in the Medicare population. Medicaid reimbursement is comparatively lower but highly variable between states. Surgeons and policymakers should advocate for fair reimbursement in both systems. Wrist arthrodesis with iliac or other autograft is the most commonly billed code using Medicare data for wrist arthrodesis surgery, but there is limited research comparing its effectiveness with other forms, such as the sliding graft.
Footnotes
Ethical Approval: This study was deemed to be exempt from institutional review board review.
Statement of Animal and Human Rights: This article does not contain any studies with human or animal subjects.
Statement of Informed Consent: No patient-related information was collected or reported in this study.
The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: PMM: Vice President and member of Council, American Society for Surgery of the Hand; Member of the Appeals Board for the Accreditation Council on Graduate Medical Education (ACGME); Associate Dean for Maintenance of Certification, Mayo Clinic School of Continuous Professional Development.
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
ORCID iDs: Adam P. Henderson 
https://orcid.org/0000-0003-4792-9338
Westin K. Keime
https://orcid.org/0009-0005-1064-3709
Jayanth Kumar
https://orcid.org/0009-0003-0076-2101
Peter M. Murray
https://orcid.org/0000-0002-4052-3338
Keith T. Aziz
https://orcid.org/0000-0003-4034-1750
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