Surgical incision and drainage of an infected or inflamed bursa located in the forearm and/or wrist region.

Verified May 8, 2026 · 8 sources ↓

Medicare: $364.07
Work RVU: 4.15
Global, days: 90
Region: Wrist

Drawn from CMSAAPCMdclarityFastrvuFindacode

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Specify the anatomic location of the bursa — forearm, wrist, or both — and whether it is superficial or deep.
Document clinical findings that confirm bursitis or infected bursa (erythema, fluctuance, warmth, culture results if available).
Record the incision approach, size of incision, volume and character of fluid drained, and any irrigation performed.
Note laterality explicitly (left, right, or bilateral) — payers increasingly require this to process claims without delay.
If complexity was substantially greater than typical (scarring, multiloculated bursa, prior failed aspiration), document that in the operative note to support modifier 22.
Confirm the diagnosis code maps to an infected or inflamed bursa — M71.x range is the expected ICD-10 family; a mismatch with an abscess code triggers claim review.

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 50 Bilateral procedure 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 XS Separate structure

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 25031 covers open incision and drainage of a bursa in the forearm and/or wrist. The surgeon makes a direct incision over the affected bursal sac, drains the contents, and irrigates the space. This is distinct from 25028, which is used for deep abscess or hematoma drainage — the target tissue here is specifically the bursa.

The 90-day global period means all routine follow-up visits, wound checks, and dressing changes are bundled through day 90. If you need to bill an unrelated procedure or E/M in that window, modifiers 79 or 24 apply, respectively. Bilateral presentation is uncommon but possible — modifier 50 applies if both forearms are treated in the same session; LT/RT are appropriate when only one side is addressed and the payer requires laterality.

Place of service matters for reimbursement. The non-facility (office) setting carries a higher total RVU than the facility setting due to practice expense differences. See the Site of Service comparison table for current values. HOPD and ASC payments differ substantially — factor that into site-of-care decisions when scheduling is flexible.

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 (4.15) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (10.9) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.15
Practice expense RVU	5.86
Malpractice RVU	0.89
Total RVU	10.9
Medicare national rate	$364.07
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	$364.07
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 25031 get rejected.

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

CPT-ICD-10 mismatch — billing 25031 with an abscess diagnosis (L02.x) instead of a bursal diagnosis (M71.x) is a frequent trigger.
Missing or ambiguous laterality — payers requiring LT/RT will reject claims that omit side designation.
Bundling with same-session E/M without modifier 25 when the decision to operate was made at that visit.
Billing during the global period of a prior forearm/wrist procedure without modifier 79 for an unrelated presentation.
Insufficient documentation to distinguish bursa drainage (25031) from deep abscess drainage (25028) — operative notes that don't name the target tissue get downcoded or denied.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01What separates 25031 from 25028?

25028 is for deep abscess or hematoma drainage. 25031 is specifically for bursa drainage. The target tissue is the distinguishing factor — your operative note must name the bursa explicitly, or auditors will question the code selection.

02Can I bill 25031 and 25028 together on the same date?

Only if the two procedures are performed at distinct, separate sites — a bursa and a deep abscess that are anatomically separate. Attach modifier 59 or XS to the secondary code to document the separate structure. Without clear documentation of two distinct sites, expect a bundling denial.

03Does the 90-day global period affect post-op wound care billing?

Yes. Routine wound checks, dressing changes, and stitch or staple removal in the 90 days following 25031 are bundled. Bill unrelated E/M visits with modifier 24 and unrelated procedures with modifier 79. A related return to the OR for complications uses modifier 78.

04Is modifier 50 correct for bilateral forearm bursa drainage in the same session?

Yes — modifier 50 applies when the identical procedure is performed bilaterally in the same session. If only one side is treated, use LT or RT as the payer requires. Some payers prefer two line items with LT and RT over a single line with modifier 50; check payer-specific instructions.

05When does modifier 22 apply to 25031?

Modifier 22 is appropriate when the work is substantially above typical — for example, a heavily scarred bursa from prior surgery, a multiloculated sac requiring extensive dissection, or an unusually prolonged procedure. Document the added complexity by name in the operative note; a vague reference to 'difficulty' won't support the modifier on appeal.

06Does site of service affect payment for 25031?

Yes, significantly. The non-facility (office) total RVU is higher than the facility RVU because practice expense is included. HOPD and ASC payments are set by separate fee schedules and differ from each other. See the Site of Service comparison table on this page for current figures.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the target structure (bursa vs. abscess vs. hematoma), anatomic location within the forearm or wrist, laterality, fluid character and volume drained, and any complicating factors such as multiloculation or prior aspiration failure. That specificity prevents the two most common denials for this code: CPT-ICD-10 mismatches when the target tissue isn't named, and downcoding to 25028 when the operative note is vague about what was drained.

See how Mira captures CPT 25031 documentation