Surgical incision into the flexor carpi radialis tendon sheath at the wrist to relieve constriction or improve tendon mobility.

Verified May 8, 2026 · 6 sources ↓

Medicare: $341.36
Work RVU: 3.7
Global, days: 90
Region: Wrist

Drawn from CMSMdclarityAAPCPayerpriceBedrockbilling

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the exact tendon sheath incised (flexor carpi radialis) and its anatomic location at the wrist — not just 'wrist tenosynovitis release'.
Document the indication: stenosis, tenosynovitis, or entrapment, with supporting clinical findings and duration of conservative treatment.
Note laterality (left vs. right) explicitly in both the operative report and diagnosis coding.
Record the surgical approach, extent of sheath release, and any intraoperative findings such as adhesions, synovitis, or tendon damage.
If modifier 22 is appended, include a separate attestation in the operative note detailing what made the procedure substantially more complex than standard.

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 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25001 describes an open incision of the flexor tendon sheath at the wrist — specifically at the flexor carpi radialis (FCR) — performed to relieve stenosis, tenosynovitis, or entrapment causing pain and restricted wrist motion. The procedure is commonly indicated in inflammatory conditions such as rheumatoid arthritis or de Quervain-type tenosynovitis affecting the FCR tunnel at the radial styloid. It differs from 25000, which targets the tendon sheath at the radial styloid more proximally.

The 90-day global period means all routine follow-up care through day 90 is bundled into the surgical payment. Any same-day E/M service must represent a significant, separately identifiable encounter unrelated to the decision to operate — append modifier 25. Post-op visits for complications or unrelated problems require modifier 24 to bypass the global bundle.

Billing site matters: the HOPD and ASC payment rates differ substantially (see the Site of Service comparison table). Most payers expect the procedure performed at an ASC or outpatient hospital setting; office-based billing is uncommon for this code and may trigger review. LT/RT modifiers are routinely expected when laterality isn't captured in the diagnosis codes.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (3.7) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (10.22) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	3.7
Practice expense RVU	5.83
Malpractice RVU	0.69
Total RVU	10.22
Medicare national rate	$341.36
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	$341.36
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI G2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 25001 get rejected.

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

Missing or inconsistent laterality — operative report says left, claim has no LT/RT modifier or diagnosis doesn't match.
Same-day E/M billed without modifier 25, or modifier 25 applied without a separately identifiable, documented encounter.
Insufficient documentation of conservative treatment failure prior to surgical intervention, triggering medical necessity denial.
Incorrect code selection — 25000 (radial styloid sheath) and 25001 (FCR sheath) are frequently confused; mismatched operative findings trigger downcoding or denial.
Post-op visits billed within the 90-day global period without modifier 24 or 79 to establish a separate, payable service.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What is the difference between CPT 25000 and 25001?

25000 describes incision of the tendon sheath at the radial styloid. 25001 describes incision of the flexor carpi radialis tendon sheath at the wrist. They are anatomically distinct procedures — select based on where the release is performed, not the symptom. Auditors look for operative note language that confirms the specific site.

02Can I bill a same-day E/M with 25001?

Only if the E/M is significant, separately identifiable, and unrelated to the decision to perform the procedure. Append modifier 25 to the E/M. The E/M and the surgery don't need different diagnoses, but the documentation must stand alone as a distinct service.

03Do I need LT or RT modifiers for 25001?

Yes. Payers routinely expect laterality modifiers for wrist procedures. If you omit LT or RT, expect either a rejection or a request for medical records. Make sure the modifier matches the operative report and the ICD-10 diagnosis code laterality.

04What ICD-10 codes commonly support 25001?

M65.819 (tenosynovitis of the wrist, unspecified), M65.811/M65.812 (right/left), and rheumatoid tendon sheath disease codes are common supporting diagnoses. The ICD-10 laterality must match the LT/RT modifier on the claim.

05What does the 90-day global cover for 25001?

All routine post-op visits, wound checks, suture removal, and care related to recovery through day 90. To bill a visit within that window, you need modifier 24 (unrelated E/M) or modifier 79 (unrelated procedure). Modifier 78 covers an unplanned return to the OR for a related complication.

06Is 25001 typically performed in the office or at a facility?

Most payers expect ASC or outpatient hospital billing for 25001. Office-based billing is uncommon for an open tendon sheath incision and may prompt a medical necessity or site-of-service review. Confirm coverage policies with your individual payers.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the specific tendon sheath incised, anatomic location at the wrist, laterality, operative findings (synovitis, adhesions, tendon integrity), and documented indication from dictation. This prevents the most common audit flag for 25001: an operative note that identifies only 'wrist tendon sheath release' without naming the FCR or confirming the wrist-level site — the distinction that separates this code from 25000.

See how Mira captures CPT 25001 documentation