| Code | Description | States | Median rate |
|---|---|---|---|
| 25000 | Wrist tendon sheath release (De Quervain's) | 48 | $293.00 |
| 25111 | Removal of a wrist ganglion cyst, first | 48 | $262.43 |
| 25112 | Removal of a recurrent wrist ganglion cyst | 48 | $316.28 |
| 25246 | Injection for a wrist X-ray (arthrogram) | 46 | $150.88 |
| 25259 | Wrist manipulation under anesthesia | 46 | $347.60 |
| 25446 | Total wrist replacement | 47 | $990.10 |
| 25500 | Closed treatment of forearm (radius) fracture without manipulation | 48 | $221.31 |
| 25505 | Radius shaft fracture, closed treatment, with manipulation | 48 | $410.20 |
| 25515 | Open treatment of a radius shaft fracture | 48 | $542.64 |
| 25530 | Closed treatment of an ulna shaft fracture, no manipulation | 48 | $210.49 |
| 25535 | Ulna shaft fracture, closed treatment, with manipulation | 48 | $391.04 |
| 25545 | Open treatment of an ulna shaft fracture | 48 | $521.26 |
| 25560 | Closed treatment of both forearm bones without manipulation | 48 | $230.63 |
| 25565 | Treatment of a broken forearm (both bones) with realignment | 48 | $433.13 |
| 25600 | Closed treatment of wrist fracture without manipulation | 48 | $259.86 |
| 25605 | Closed treatment of wrist fracture with manipulation | 48 | $455.36 |
| 25607 | Open repair of wrist fracture with plate or screws | 48 | $564.64 |
| 25622 | Scaphoid wrist fracture, closed treatment, no manipulation | 48 | $244.43 |
| 25624 | Closed treatment of a scaphoid wrist fracture, manipulation | 48 | $400.78 |
| 25900 | Forearm amputation | 46 | $586.32 |
| 25905 | Forearm amputation, open (guillotine) | 46 | $543.20 |
| 25920 | Amputation through the wrist joint | 46 | $558.60 |
| 25999 | Unlisted forearm or wrist procedure | 12 | $204.84 |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Descriptions are ProviderSignal's own plain-language labels or public-domain CMS text.