CPT Updates 2025: New and Revised Codes for Musculoskeletal and Telemedicine Services

The American Medical Association (AMA) provides code and guideline changes to the Current Procedural Terminology (CPT) Manual each year. This article will preview relevant changes to the musculoskeletal section for 2025. For a full summary of the additions, deletions, and revisions, refer to Appendix B of the CPT Manual.

Musculoskeletal System: Forearm, Wrist, Hand subsection
Revisions made to the carpometacarpal and midcarpal arthroplasty codes include several new parenthetical guidelines, one new code, and one revised code. The new parenthetical guideline for code 25310, Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single; each tendon, instructs users not to report the code in conjunction with codes for intercarpal or carpometacarpal joint arthroplasty (i.e., 25447, 25448).

Code 25447, Arthroplasty, intercarpal or carpometacarpal joints; interposition (eg, tendon), was revised to move the term “interposition” and add the parenthetical example tendon.

A new code, 25448, Arthroplasty, intercarpal or carpometacarpal joints; suspension, including transfer or transplant of tendon, with interposition, when performed, was added for the reporting of suspension arthroplasty and includes the transfer or transplant of the tendon as well as interposition of tendons when performed. Therefore, interposition is not separately reported with this procedure. Exclusionary parenthetical guidelines were added to instruct users regarding the appropriate reporting of these procedures.

Similarly, a corresponding parenthetical guideline was added for code 26480, Transfer or transplant of tendon, carpometacarpal area or dorsum of hand; without free graft, each tendon, which instructs not to report in conjunction with codes 25447 and 25448 when performed for intercarpal or carpometacarpal joint arthroplasty.

Note that the excision of the trapezium or other carpal bone is included in code 25447. The only time the excision of bone is not included is for the treatment of a secondary diagnosis. The removal of bone is included if the secondary procedure is another arthroplasty. One can no longer code a ligament reconstruction and tendon interposition arthroplasty utilizing 25447 with a tendon transfer code. It is to be used specifically for interposition arthroplasty alone. For example, this occurs when a trapeziectomy is performed, and a portion of the flexor carpi radialis tendon (FCR) is harvested, rolled up, and secured in the arthroplasty space. A Kirschner wire, also referred to as a K-wire, may or may not be used to provide initial stabilization of the first metacarpal.

The new code 25448 includes the work of tendon transfer but does not necessitate the use of a tendon transfer. It is a code for arthroplasty with suspension of any type. As always, documentation remains important. Ensure that the records specify that suspension was performed and indicate how this is being achieved. The following are three examples:

1. A portion of the FCR is transferred to the first metacarpal.
2. A suture suspension is performed by weaving a suture between the abductor pollicis longus tendon and FCR tendons.
3. A suture suspension device is placed between the first and second metacarpals.

If one is performing a concomitant procedure that requires a tendon transfer in an area other than the carpometacarpal or intercarpal joints, then that may be reported separately. The documentation must reflect the separate diagnosis and anatomic area where that transfer is being performed and specify that it is not related to the arthroplasty performed.

The AMA Relative Value Update Committee relative value unit values of the current tendon transfer codes 25310 and 26480 now more accurately reflect the work performed (transferring a donor tendon to a recipient tendon in the setting of tendon rupture or nerve palsy).

Evaluation and Management: Telemedicine Services
A new subsection for telemedicine services was created, with 17 new codes and accompanying guidelines for reporting synchronous (real-time) evaluation and management (E/M) services. These new telemedicine codes describe interactive encounters between the patient and the physician or other qualified healthcare professional in real time. The CPT Manual contains a new table, “Telemedicine and Non-Face-to-Face Services,” to assist in code selection. The table categorizes new/established patient status, MDM or time for level reported, date or time period of the service, and exclusionary guidelines.

Synchronous audio-video E/M services codes 98000 to 98007 are reported for new or established patients, with real-time audio and video telecommunication both being required. Services are reported based on either the total time on the date of service or on medical decision making.

Synchronous audio-only E/M services codes 98008 to 98015 are reported for new or established patients, without the requirement of video telecommunications.

These audio-only codes require more than 10 minutes of medical discussion. If there is only 5 to 10 minutes, then users are to report the new virtual check-in code 98016 as appropriate. However, if the 10 minutes is exceeded for the audio-only service, then the total time on the date of service or the medical decision making may be used for code level selection. Both sets of synchronous telemedicine codes follow the same structure as the office or other outpatient E/M codes.

Anne N. Miller, MD, contributed to the creation of this article.

Michelle Abraham, MHA, CCS-P, is coding and reimbursement coordinator in the AAOS Office of Government Relations.

Webinar: CPT & CMS Updates 2025

On Jan. 9, AAOS hosted a webinar on current changes to the 2025 Current Procedural Terminology (CPT) codes and Centers for Medicare & Medicaid Services (CMS) payment policies related to orthopaedics. Visit learn.aaos.org to access a recording of the webinar.