Surgical incision into the extensor tendon sheath at the wrist to decompress and release a constricted or contracted tendon.

Verified May 8, 2026 · 5 sources ↓

Medicare: $340.36
Total RVUs: 10.19
Global, days: 90
Region: Wrist

Drawn from CMSCarepatronMedibillmdAAPC

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 5 cited references ↓

Specify laterality (left or right wrist) — required for modifier LT/RT assignment and payer claim adjudication.
Identify the exact extensor compartment and tendon sheath released (e.g., first dorsal compartment for De Quervain's).
Document the clinical indication with supporting objective findings — positive Finkelstein test, ultrasound, or MRI evidence of tenosynovitis.
Describe the incision technique, structures encountered, and confirmation of tendon decompression and free gliding post-release.
Record conservative treatment attempted prior to surgery (corticosteroid injections, splinting, physical therapy) to support medical necessity.
Note any unusual complexity, intraoperative findings, or extended operative time if modifier 22 is appended.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 25000 reports an open incision of the extensor tendon sheath at the wrist, performed to relieve constriction, reduce intracompartmental pressure, and restore tendon gliding. The classic indication is De Quervain's tenosynovitis — compression of the first dorsal compartment tendons — but the code applies to any extensor sheath release at the wrist when the primary goal is decompression rather than drainage or synovectomy. The surgeon incises the sheath, verifies tendon mobility, and closes the wound; local anesthesia, incision, sheath release, and routine wound closure are all included in the code.

The 90-day global period covers the day-before visit, the operative session, and all routine postoperative management through day 90. Separate E/M visits during that window for unrelated conditions need modifier 24. If a staged or unrelated procedure is performed during the global period, modifier 79 applies. Modifier 78 is reserved for an unplanned return to the OR for a complication directly related to the original sheath incision.

Differentiate 25000 from adjacent codes before billing: 25001 adds drainage of an infected or fluid-filled sheath; 25118 is a synovectomy of the extensor tendon sheath — more extensive tissue removal, higher complexity. Billing 25000 when operative notes describe synovial tissue excision is a common audit flag.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	3.46
Practice expense RVU	6.07
Malpractice RVU	0.66
Total RVU	10.19
Medicare national rate	$340.36
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$340.36
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 25000 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Missing laterality in the operative note or on the claim — payers routinely reject without LT or RT when bilateral structures are involved.
Insufficient documentation of failed conservative management before surgical intervention, triggering medical necessity denial.
Operative note describes synovial tissue excision or debridement, misaligning with 25000 and triggering a code-to-documentation mismatch; 25118 may be the correct code.
Billing a separate E/M visit during the 90-day global period without modifier 24, causing bundling denial.
Diagnosis code does not map to extensor tenosynovitis or a condition requiring sheath release — ICD-10 mismatches are a top trigger for claim rejection.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What is the difference between CPT 25000 and 25001?

25000 is a straightforward extensor sheath incision for release of contracture or decompression. 25001 adds drainage — use it when the sheath contains purulent fluid or an abscess requiring evacuation. Billing 25000 when the operative note documents drainage is a coding error.

02How does 25000 differ from 25118?

25118 is a synovectomy — it involves excision of inflamed synovial tissue from the extensor tendon sheath, a more extensive procedure. If your operative note describes only incision and release without tissue removal, 25000 is correct. If synovial tissue was excised, 25118 is the right code. Auditors cross-reference the operative description against the billed code.

03Which modifiers are most commonly used with 25000?

LT and RT are used to designate laterality. Modifier 22 applies when the procedure was significantly more complex than usual — document the added time and difficulty explicitly. Modifier 52 applies if the procedure was intentionally reduced. Modifier 59 or XS may be needed when billing 25000 alongside another distinct wrist procedure on the same date.

04Can 25000 be billed bilaterally?

Yes. Bilateral procedures require modifier 50 or separate line items with LT and RT. Confirm payer preference — some commercial payers want modifier 50 on one line, others want two lines. Medicare generally accepts modifier 50 with the appropriate fee schedule adjustment.

05What ICD-10 codes support medical necessity for 25000?

Common supporting diagnoses include M65.311–M65.319 (De Quervain's tenosynovitis by laterality), M65.811–M65.819 (other tenosynovitis of the wrist), and M67.331–M67.339 (transient synovitis). The chosen diagnosis must reflect documented clinical findings and failed conservative measures.

06Does the 90-day global period affect post-op billing?

Yes. Routine follow-up visits, dressing changes, and stitch removal within 90 days are included in 25000 — bill those separately and expect denial without modifier 24 (unrelated E/M) or modifier 79 (unrelated procedure). An unplanned return to the OR for a related complication uses modifier 78.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

The Mira AI Scribe captures the specific extensor compartment released, the laterality, intraoperative confirmation of tendon gliding post-release, and any documentation of prior conservative treatment from dictation. This prevents the two most common denials for 25000: missing laterality and lack of documented medical necessity before surgery.

See how Mira captures CPT 25000 documentation