Surgical incision and drainage of a deep abscess or hematoma located in the forearm and/or wrist, accessing structures beneath the superficial fascia.

Verified May 8, 2026 · 6 sources ↓

Medicare: $688.06
Total RVUs: 20.6
Global, days: 90
Region: Wrist

Drawn from FindacodeMdclarityAAPCCMS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm and document that the abscess or hematoma involved deep structures below the superficial fascia, not just subcutaneous tissue
Operative note must name the anatomic structures entered during dissection and the depth of the collection
Document laterality (left, right, or bilateral) for every forearm/wrist procedure
Record drain type and placement if a drain was left in situ post-procedure
Include the pre-operative diagnosis with supporting imaging or clinical findings that justify the deep classification
Document irrigation volume and any cultures obtained intraoperatively

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 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 XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25028 covers open incision and drainage of a deep-seated abscess or hematoma in the forearm or wrist. 'Deep' is the operative word here — this code is reserved for infections or hematomas involving structures below the superficial fascia, not superficial skin-level collections. The surgeon opens the skin, dissects through overlying tissue, evacuates the collection, irrigates, and typically places a drain. It is not the right code for a simple superficial abscess of the forearm skin.

The 90-day global period applies. All routine post-op visits, wound checks, and drain management through day 90 are bundled. Separate E/M visits during the global require modifier 24 (unrelated) or modifier 25 (same-day, significant and separately identifiable, pre-procedure). If the patient returns to the OR for further drainage of the same infection during the global period, bill modifier 78. If a completely unrelated procedure is performed during the global window, use modifier 79.

Side specificity matters for bilateral presentations. Append LT or RT to identify which forearm was treated. If both forearms are drained in the same session, modifier 50 applies. Document the depth of the collection, structures encountered, and drain placement explicitly — auditors routinely challenge whether the pathology was truly deep vs. superficial, which would redirect the claim to a lower-value code.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.26
Practice expense RVU	14.27
Malpractice RVU	1.07
Total RVU	20.6
Medicare national rate	$688.06
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	$688.06
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 25028 get rejected.

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

Payer downcodes to a superficial I&D code when operative note fails to establish deep fascial involvement
Missing laterality modifier (LT/RT) triggers claims edits with Medicare and many commercial payers
Global period conflict when post-op visits are billed without modifier 24, appearing as duplicate services
ICD-10 diagnosis code mismatch — abscess or hematoma code does not specify the forearm/wrist region, failing specificity requirements
Bilateral procedures billed as two separate line items without modifier 50, triggering NCCI edits

Frequently asked questions

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

01What separates 25028 from a superficial forearm I&D code?

Depth is the differentiator. CPT 25028 requires that the abscess or hematoma involve structures deep to the superficial fascia. Superficial skin and subcutaneous collections on the forearm route to lower-value codes. Your operative note must document the fascial plane entered to hold 25028 on audit.

02Do I need LT or RT every time?

Yes. Medicare and most commercial payers require laterality for unilateral forearm procedures. Missing LT or RT is a routine claims edit trigger. If you drained both forearms in one session, bill 25028 with modifier 50 on a single line.

03If the patient returns for re-drainage of the same infection two weeks post-op, how do I bill?

Use modifier 78. This signals an unplanned return to the procedure room for a related procedure during the 90-day global period. Do not bill without a modifier — the claim will deny as a duplicate within the global.

04Can I bill a separate E/M on the same day as 25028?

Only if the E/M was a significant, separately identifiable service beyond the pre-procedure assessment — and you append modifier 25 to the E/M. Without modifier 25, the E/M is bundled into the surgical package and will not pay separately.

05Is radiologic guidance separately billable with 25028?

If imaging guidance (e.g., ultrasound) was used to localize the collection and a separate CPT code exists for that guidance, it may be billable — but only if the 25028 descriptor itself does not include it. Per NCCI Chapter IV, guidance integral to the procedure cannot be unbundled. Document medical necessity for imaging guidance separately.

06What ICD-10 codes typically support medical necessity for 25028?

Deep forearm or wrist abscess codes (e.g., L02.11x for cutaneous abscess of the hand/wrist region), hematoma codes, and postoperative deep wound infection codes are the typical pairings. Use the most anatomically specific code available — nonspecific soft tissue infection codes draw scrutiny.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures depth of involvement (subfascial vs. superficial), structures encountered during dissection, drain type and placement, laterality, irrigation volume, and intraoperative culture status directly from the surgeon's dictation. That structured capture prevents the most common audit challenge — an operative note that says 'deep abscess' without documenting the tissue planes traversed — which is the primary trigger for downcoding to a superficial I&D code.

See how Mira captures CPT 25028 documentation