CPT code 25310: Tendon transfer, RVU values and fee schedule

Key takeaways

CPT code 25310 describes tendon transplantation or transfer (flexor or extensor) in the forearm and/or wrist, billed per tendon as a single unit.

CY2026 values are 8.78 work RVUs, 9.56 practice expense RVUs and 1.67 malpractice RVUs, for a total of 20.01 RVUs.

CMS applies no facility versus non-facility split to this code. The estimated national Medicare payment is roughly $668 in either setting.

Modifiers 51 (multiple procedures), LT/RT (laterality) and 59 (distinct procedural service) are the ones most often applied. Incorrect use triggers denials.

Practice management software like Pabau helps orthopedic and hand surgery teams apply modifiers accurately and keep fee schedule values current.

CPT code 25310 covers tendon transplantation or transfer of a flexor or extensor tendon at the forearm or wrist. It is billed once per tendon moved, not once per operative session.

This page sets out the CY2026 RVU values, the Medicare payment estimate, the modifiers that apply, and the ICD-10-CM codes that support medical necessity. One detail trips up billing teams. CPT code 25310 carries no facility versus non-facility payment split, even though plenty of published summaries show one.

The American Medical Association (AMA) publishes and maintains the CPT code set. According to the AMA, CPT code 25310 carries the following official descriptor:

The phrase “single, each tendon” in the descriptor is critical. It means CPT code 25310 is billed once per tendon transferred. If a surgeon transfers two tendons in the same operative session, two units of 25310 are billed. Each unit needs documentation confirming the distinct procedures.

Clinical indications: When is CPT code 25310 used?

CPT code 25310 applies when a surgeon transplants or transfers a flexor or extensor tendon in the forearm and/or wrist region. The code covers both transplantation (using a donor graft) and transfer (rerouting an existing tendon to restore function).

Common clinical scenarios include post-traumatic tendon rupture, rheumatoid arthritis complications, and nerve palsy deficits requiring tendon rerouting. Practices specializing in upper-extremity care, such as those using physical therapy EMR software or sports medicine software, encounter this code regularly.

• EIP to EPL transfer: Transfer of the extensor indicis proprius (EIP) to replace a ruptured extensor pollicis longus (EPL) tendon. The usual cause is a distal radius fracture. This is one of the most frequently coded scenarios under CPT 25310.
• Rheumatoid arthritis reconstruction: Extensor tendon rupture secondary to rheumatoid disease, where multiple tendons may require transfer in a single session.
• Radial nerve palsy reconstruction: Flexor-to-extensor transfers restoring wrist and finger extension after high radial nerve injuries.
• Post-traumatic flexor tendon transfer: Restoration of digit flexion following crush injury or laceration where primary repair is not viable.
• Ulnar nerve palsy correction: Tendon transfers to restore intrinsic muscle function at the wrist level.

The code does not apply to tendon repairs, which are CPT 25260 or 25270. Tenodesis at the wrist is CPT 25300 for finger flexors and CPT 25301 for finger extensors. Procedures at the digit level belong in the 26000-series codes. Getting the anatomical level right is the first step in avoiding downcoding or denial.

RVU values for CPT code 25310

The Centers for Medicare and Medicaid Services (CMS) sets relative value unit (RVU) data each year through the Medicare Physician Fee Schedule (MPFS). The figures below come from the CY2026 Physician Fee Schedule relative value file. Check them against the CMS Physician Fee Schedule lookup tool before you submit, because CMS revises RVUs annually.

Both columns match, and that is not a typographical error. CMS assigns CPT code 25310 one practice expense RVU of 9.56, so the site of service does not move the total. At the CY2026 conversion factor of $33.40, the national estimate works out to about $668. Clinicians paid at the qualifying APM participant rate of $33.57 see roughly $672.

CPT code 25310 fee schedule and reimbursement rates

Medicare reimbursement for CPT code 25310 starts from the same 20.01 total RVUs wherever the procedure is performed. Geography moves the number, the setting does not. Treat the national average as a starting point rather than a billing guarantee.

Facility vs non-facility rates

There is no facility versus non-facility payment difference for CPT code 25310. CMS applies the same practice expense RVU of 9.56 in both settings, so the total stays at 20.01 RVUs either way. That is approximately $668 nationally, whether the tendon transfer happens in a hospital, an ambulatory surgery center, or an office.

A site-of-service differential does exist for many other codes. CMS applies one where it expects the practice to carry the supply and staffing costs itself. The fee schedule carries no such split for CPT code 25310. Any fee schedule showing a facility and non-facility difference for this code was built from bad data.

The hospital or surgery center still bills its own facility fee for the case. That payment goes to the institution under a separate methodology. It has no bearing on what the surgeon is paid under the Physician Fee Schedule for CPT code 25310.

Medicare allowable and payer considerations

Medicare allowable amounts for CPT code 25310 differ by locality. Look up your own Medicare Administrative Contractor (MAC) locality in the CMS fee schedule search. No practice is paid the national figure.

Commercial payers negotiate rates independently. Most private insurers price against the Medicare fee schedule, commonly at 110% to 140% of it. Contracted rates still vary widely, so check your own payer contracts before projecting revenue for this procedure.

Pre-authorization requirements also vary by payer. No universal rule applies. Confirm the prior authorization process with each carrier before you schedule the surgery.

Modifiers for CPT code 25310

Modifier selection for CPT code 25310 directly affects whether a claim pays or denies. The table below summarizes the most commonly applied modifiers with guidance on when each is appropriate.

Individual payer policies can override the standard multiple-procedure reduction rule that governs modifier 51. Verify carrier-specific modifier rules before submission. Incorrect modifier application on CPT code 25310 claims is one of the top denial triggers for orthopedic billing teams.

ICD-10-CM codes commonly linked to CPT code 25310

Medical necessity for CPT code 25310 must be supported by a specific, appropriately coded diagnosis. The ICD-10-CM codes below represent the most common diagnostic crosswalk. Verify each code against the current-year tabular list before filing, as codes are revised annually.

Swap the final laterality digit on the G56 codes for a left-sided palsy. Select the most specific code that reflects the documented clinical picture, because “unspecified” codes are a common audit flag when precise options exist. Hand-level and sequela codes such as S61.314S sit outside this crosswalk, since 25310 is a forearm and wrist procedure. The AAPC Codify platform publishes crosswalk references that help coders confirm medical necessity pairing.

Related CPT codes: CPT code 25310 vs repair, tenodesis and arthroplasty

Choosing between closely related forearm and wrist tendon codes is a common source of coding errors. The table below compares CPT code 25310 with the codes most often confused with it. Other upper-extremity procedures, such as 25676 at the wrist at the wrist and 24582 at the elbow, follow the same level-based logic.

The most clinically important distinction is between 25310 and the primary repair codes 25260 and 25270. A repair reattaches the original tendon end-to-end. A transfer reroutes a functioning tendon to a new insertion point. The operative note must state clearly which procedure was performed. Verify all related codes using the CMS list of CPT/HCPCS codes for annual coverage updates.

Billing and documentation requirements for CPT code 25310

Clean claims for CPT code 25310 hinge on the operative note. Payers audit hand surgery procedures for specificity, and incomplete documentation is the most common reason for post-payment recovery demands. Meeting HIPAA compliance standards across those records reduces liability exposure at the same time.

• Per-tendon documentation: The operative report must identify each tendon transferred by name (e.g., EIP to EPL), confirming the donor and recipient sites. Billing two units of 25310 without naming two distinct tendons is an overbilling risk.
• Procedure type clarity: The note must distinguish transfer (rerouting) from transplantation (graft) and from repair (end-to-end). Using the terms interchangeably in the operative dictation creates ambiguity that payers exploit during audits.
• Anatomical level: Document that the procedure occurred at the forearm and/or wrist level, not at the digit level. Mislabeling anatomy shifts the correct code family entirely.
• Medical necessity: Link the procedure to the ICD-10-CM diagnosis code in the operative note. Payers increasingly require the indication to appear explicitly in the documentation, not just on the claim form.
• Pre-authorization status: Record the auth number in the billing file when prior authorization was obtained. Submitting without a required auth number triggers automatic denial at most commercial payers.
• Global period awareness: CPT 25310 carries a 90-day global surgical period. Services within that period that are not separately identifiable need modifier 24 or modifier 79 to bypass the global edit.

Common billing errors and denial reasons for CPT code 25310

Most denials on this code trace back to five recurring problems. Each one is visible in the operative note or the charge entry screen before the claim goes out.

• Units billed without named tendons: Two units of 25310 require two tendons identified by name in the operative report. A generic reference to “tendon transfers” will not survive a post-payment review.
• A stale fee schedule with a phantom non-facility rate: Some third-party fee schedule products still list a separate non-facility figure for 25310. Loading that into your billing system inflates expected revenue and creates variance you cannot reconcile.
• Repair coded as transfer: An end-to-end reattachment is 25260 or 25270, not 25310. The wrong choice here is both an overpayment risk and a compliance one.
• Missing laterality: Claims without LT or RT reject at many carriers before an adjudicator ever sees them. Set laterality as a required field at charge entry.
• Global period collisions: The 90-day global period on 25310 absorbs routine follow-up. Unrelated services inside that window need modifier 24 or modifier 79 to pay.

Denial patterns cluster by payer. Tracking them by carrier is faster than auditing every claim, because one carrier’s modifier policy usually explains most of the volume. Map the denial codes you see most often to a fix, then build a denial management routine around the two or three that keep recurring.

How practice management software supports CPT 25310 billing

Orthopedic and hand surgery billing is procedurally complex. A single operative session can involve multiple tendon transfers, a nerve procedure, and a fracture repair. That generates four or more CPT codes. Each one needs the right modifiers, current fee schedule values, and complete ICD-10 linkage.

Practice management software like Pabau takes that load off the billing team at the point of charge entry. Our claims management software matches CPT codes to current-year fee schedule values and flags modifier conflicts before submission. Claims reach the clearinghouse through our Claim.MD integration, so submissions and remittances stay in one system.

Every subscription includes the full set of practice management software features, so a two-surgeon practice gets the same billing tools as a twenty-site group.

• Fee schedule maintenance: Automatically update Medicare allowable amounts and payer contract rates when CMS releases annual MPFS data, reducing manual re-entry errors.
• Modifier rule engine: Flag conflicting modifier pairs, such as modifier 51 on a procedure exempt from the multiple-procedure reduction, before the claim leaves the practice.
• ICD-10 to CPT linkage: Link diagnosis codes to procedure codes at the point of charge entry. Fewer mismatched medical necessity codes reach the payer.
• Claim scrubbing: Run every submission through real-time edits, so a clean claim reaches the payer on the first attempt.
• Denial tracking: Monitor denial rates by CPT code and payer. Billing managers can see which carrier is denying CPT code 25310, then investigate the root cause.

Practices that connect scheduling, documentation, and billing in one platform cut the handoff errors behind most claim denials. Patient scheduling software feeding the same record means the surgical case, the operative note, and the charge all reference one source.

Reduce claim denials for orthopedic procedures

Pabau’s claims management software helps hand surgery and orthopedic practices apply modifiers correctly and keep fee schedules current. Cleaner claims go out for CPT 25310 and related codes.

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Conclusion

CPT code 25310 is a per-tendon code that pays 20.01 RVUs, or roughly $668 nationally, in every setting. The expensive mistakes happen after the surgery, in the operative note and the charge entry. A missing tendon name, the wrong modifier, or an unlinked diagnosis each costs a practice money.

So does a fee schedule still carrying a non-facility rate that CMS does not publish. Audit your loaded values for this code once, fix the operative note template, and the denial volume follows.

Pabau’s claims management platform helps orthopedic and hand surgery practices build those workflows before a claim reaches the payer. To see how Pabau handles surgical billing for high-complexity procedure codes, book a demo with the team.

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