CPT Code 25110: Excision of tendon sheath lesion, forearm and wrist

Key takeaways

CPT Code 25110 covers excision of a lesion of the tendon sheath, forearm and/or wrist.

Medicare assigns the code 3.94 work RVUs and 10.11 total RVUs in the 2026 fee schedule.

Medicare marks the office rate as not applicable, so 25110 pays the facility rate in every setting.

The code carries a 90-day global period, so routine post-op visits are bundled into the surgical payment.

Site and extent decide the code. A wrist ganglion belongs to 25111, and the hand or finger belongs to 26160.

What is CPT Code 25110?

CPT Code 25110 covers the excision of a lesion of the tendon sheath, forearm and/or wrist. It belongs to the 25000 musculoskeletal series of the Current Procedural Terminology (CPT) code set. Medicare treats the procedure as major surgery, so it carries a 90-day global period.

The code applies to a lesion growing on the sheath itself. It does not cover the joint capsule, the bone, or a wrist ganglion that arises from the joint. That one distinction decides whether the claim pays or comes back for review.

The payment side holds a surprise that catches out even experienced coders. Medicare marks the non-facility practice expense for 25110 as not applicable. In plain terms, the office rate that most surgical codes carry simply does not exist for this one.

Clinical overview: when tendon sheath excision is indicated

The tendon sheaths of the forearm and wrist are synovial-lined tunnels that let tendons glide without friction. A lesion can grow on the sheath itself. Surgeons remove it once splinting, injection, or activity change has failed to settle the symptoms.

CPT Code 25110 applies when the surgeon excises that lesion in the forearm or wrist region. Anatomy drives the code choice. A tendon sheath lesion of the hand or finger routes to CPT 26160, which covers both sites, not the finger alone.

• Giant cell tumor of tendon sheath: Benign but locally aggressive, and it needs complete excision to reduce recurrence.
• Ganglion arising from the sheath: Supports 25110 only when the operative note names the sheath as the origin.
• Tenosynovitis nodules: Inflammatory thickening of the sheath, sometimes debulked after a failed steroid injection.
• Fibroma of tendon sheath: A rare, slow-growing fibrous nodule stuck to the sheath.

The procedure usually happens under regional or general anesthesia in a hospital outpatient department or an ambulatory surgery center. Coders at orthopedic and sports medicine practices should confirm the operative report names the tendon sheath as the source of the lesion. A capsule origin points to 25105 instead.

Choosing between 25110 and the adjacent wrist codes

Adjacent code confusion is the leading denial trigger for wrist soft tissue excisions. Two questions settle it every time. Which structure did the lesion come from, and how much tissue did the surgeon remove?

Note what 25115 and 25116 do not split on. Neither code involves resection of bone. They divide the wrist into the flexor side and the extensor side. Code 25116 also covers transposition of the dorsal retinaculum when the surgeon performs it.

The operative note has to name the anatomical site and the structure that was excised. A ganglion documented as arising from the dorsal wrist joint supports 25111, not 25110. Procedures on the digits move into the 26000 series, where CPT 26080 handles arthrotomy of the interphalangeal joint.

ICD-10 diagnosis codes that support CPT Code 25110

Payers need a supported ICD-10-CM diagnosis to establish medical necessity. The codes below pair with CPT Code 25110 most often. Pairing one does not guarantee coverage, because each payer’s Local Coverage Determination sets its own accepted list.

Code to the highest specificity the chart supports. A note reading “right wrist ganglion cyst” calls for M67.431 rather than the unspecified M67.40. The same discipline applies across the musculoskeletal chapter. An unspecified entry such as M89.9 invites a request for records. A laterality-specific code such as S52.131B does not.

Medicare reimbursement and RVU data for CPT Code 25110

Medicare pays for CPT Code 25110 through the Resource-Based Relative Value Scale. The figures below come from the 2026 Physician Fee Schedule relative value file, April release. You can download the same file from the CMS relative value files page.

The math is straightforward. Multiply the 10.11 total RVUs by the 2026 conversion factor of $33.4009 and you get $337.68. That is a national figure before any geographic adjustment.

The Geographic Practice Cost Index then moves the number by locality. A practice in Manhattan collects more than one in rural Alabama for identical work. Never hard-code a dollar figure into a billing policy. Pull the locality rate from the CMS Physician Fee Schedule lookup for the year you are billing.

Why 25110 has no separate office rate

Most surgical codes carry two practice expense values, one for the facility and a higher one for the office. CPT 25110 does not. CMS flags its non-facility practice expense as not applicable, which is the agency’s way of saying the procedure is not performed in an office.

The practical effect is simple. Whatever place of service you report, the physician payment lands at the same 10.11 total RVUs. There is no office premium to chase, and no setting that quietly pays more for the same operation.

A claim for 25110 billed with POS 11 will draw attention, because the procedure needs sterile surgical conditions. Confirm the place of service matches the operative report before you submit. Billing teams at physical therapy and musculoskeletal practices that coordinate referrals can catch a mismatch at the scheduling stage.

Global period and post-operative billing rules

CPT Code 25110 carries a 90-day global surgical period under the CMS major surgical global package. The surgeon’s payment therefore covers related pre-operative and post-operative care for 90 days after the procedure date.

• Included in the global package: Pre-operative visits the day before or the day of surgery, routine follow-up, and complications managed outside the operating room.
• Billable separately: Unrelated E/M services in the window, complications that need a return to the OR, and care by another physician for an unrelated problem.
• Modifier -24: Add it to an E/M service in the global period to show the visit is unrelated. Support it with a diagnosis that clearly differs from the surgical one.
• Modifier -78: Use it for a return to the OR for a complication of the original procedure.
• Modifier -79: Use it for a procedure in the global period that is unrelated to the original surgery.

Practices that run several procedures per patient need the 90-day clock visible to whoever books the follow-up. Put the surgery date and the global end date on the patient record, not in a coder’s spreadsheet. A front desk that can see the window will stop booking post-op visits as billable office visits.

Modifiers for CPT Code 25110

Modifier choice on CPT Code 25110 affects both payment and claim integrity. A missing or wrong modifier leads to a denial, and sometimes to a compliance problem. Apply each one only when the clinical circumstances genuinely warrant it.

Medicare gives 25110 a bilateral surgery indicator of 1, so the 150% payment rule applies. Bill modifier -50 on one line, or use two lines with -LT and -RT. Check your Medicare Administrative Contractor’s preference first, because the convention varies by jurisdiction.

Prior authorization requirements

Medicare does not require prior authorization for CPT Code 25110 under standard fee-for-service. Commercial plans and Medicare Advantage are another matter. Many of them pre-authorize elective musculoskeletal surgery, soft tissue excisions of the wrist included.

• Clinical notes: Symptom duration, functional impairment, and every conservative treatment already tried.
• Imaging: Ultrasound or MRI showing the size of the lesion, its location, and its relationship to the tendon sheath.
• Failed conservative care: Six weeks is a common payer threshold before an elective case is approved.
• ICD-10 alignment: The diagnosis on the request must match the one on the claim, laterality subcode included.

That conservative treatment history is worth billing properly in its own right. A steroid injection into the sheath is reported with CPT 20551, and a therapy assessment with CPT 97161. Both create the documented trail a payer asks for when the surgical request lands.

Authorization rules change often, so never assume last year’s policy still holds. Check the payer portal or call provider relations before you schedule an elective case. Tracking authorization status next to the appointment stops same-day cancellations.

Billing documentation requirements

Every CPT Code 25110 claim needs an operative report that supports the code. Payers audit surgical claims for completeness, and a thin note is the quickest route to a medical necessity denial or a post-payment recoupment.

• The anatomical location of the lesion, forearm or wrist, with laterality stated
• Confirmation that the lesion arose from the tendon sheath rather than the joint capsule or bone
• A description of the surgical approach and the excision technique
• The pathology report identifying the specimen when tissue was sent
• Pre-operative and post-operative diagnoses that match the ICD-10 code billed
• Medical necessity: symptom duration, failed conservative care, and functional impairment

Specimen handling deserves its own line in the checklist. Codes that hinge on what came out of the wound, such as CPT 20245 and CPT 24138, get denied for the same reason 25110 does. The pathology report never made it onto the claim.

A checklist review at the coding stage catches most of this before submission, which beats amending records later. Storing the operative note, the pathology result, and the consent in one HIPAA-compliant record means an auditor’s request takes minutes rather than days.

Common billing errors and how to avoid them

Most CPT Code 25110 denials trace back to a short list of recurring mistakes. Once you know the patterns, a pre-submission checklist catches nearly all of them.

• Upcoding to 25115: Choosing radical excision when the note describes removal of one discrete lesion. The word radical has to appear, and the flexor tendon sheaths have to be involved.
• Reaching for 25110 on a wrist ganglion: A ganglion arising from the joint belongs to 25111, or 25112 if it has recurred.
• Using 26160 for a wrist case: 26160 covers the hand and the finger. A lesion at the wrist or forearm is 25110, however similar the surgery looks.
• Unspecified ICD-10 codes: Submitting M67.40 when the chart names the side and the site. Payers treat unspecified codes as unsupported.
• Missing -LT or -RT: Many commercial payers require a laterality modifier and will auto-deny without one.
• Post-op E/M without modifier -24: A visit inside the 90-day window bundles into the surgical payment unless the diagnosis is clearly unrelated.
• NCCI conflicts: Check the CMS edit table before you bill 25110 with an adjacent code. Some pairs need modifier -59, but only when the services really are distinct.

Staying current on National Correct Coding Initiative edits is not optional. The AAPC CPT code lookup gives coders a quick cross-reference for edit conflicts before submission. Practices with high musculoskeletal volume get further with automated claim scrubbing than with manual spot checks.

How Pabau keeps 25110 claims moving

The coding decisions on this page happen in the operative note. The billing problems happen afterwards, when nobody can tell which claims went out, which were accepted, and which quietly errored two weeks ago. Most practices find that out from a remittance, not from a dashboard.

Practice management software like Pabau keeps the surgical record and the claim in one place. Your clinicians record the codes on the treatment note, and Pabau’s claims management software pulls that existing record data into a pre-filled claim. It checks the required fields are populated before submission, so a claim does not fail on a missing detail.

From there you can watch each claim move through submitted, processing, paid, or error, without logging into a separate portal. A biller can see the stuck 25110 claims in the morning and work them the same day. That is the difference between chasing reimbursement and simply collecting it.

Keep every surgical claim visible

Pabau pulls the codes already on your treatment note into a pre-filled claim, checks the required fields, and tracks each submission through to payment. Your billers spend their time on the claims that stalled.

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Conclusion

CPT Code 25110 has a plain descriptor and a stubborn denial rate. Almost every rejection comes back to the same two lines in the operative note: which structure the lesion grew from, and which wrist it was.

Get those two right and the rest follows. The RVUs are fixed at 10.11, the setting does not change the physician payment, and the 90-day window is predictable once someone owns it. The trade-off worth remembering is that none of this is a coding problem you can fix at the coding stage. It is a documentation habit, and it is set in the operating room.

Practices that tighten the note and keep claim status in front of the billing team see the rework on musculoskeletal claims drop. Book a demo to see how Pabau connects surgical records to claim tracking for orthopedic and sports medicine teams.

Continue your research

Coding a soft tissue flap on the digits? CPT code 14350 sets out the documentation and modifier rules for filleted finger and toe flaps.

Sending tissue from a musculoskeletal case to pathology? CPT code 20200 explains how specimen documentation drives payment on biopsy claims.

Billing an upper limb fracture alongside wrist surgery? CPT code 23605 covers manipulation, global periods, and the modifiers that apply.

Coding a forearm wound after the treatment has finished? ICD-10 code S51.801S shows how the sequela seventh character changes the claim.

Documenting a forearm fracture that failed to unite? ICD-10 code S52.209K walks through nonunion coding and the records payers ask for.

Frequently asked questions