Surgical · Wrist

Deep incision into the bone cortex of the forearm and/or wrist, performed to treat conditions such as osteomyelitis or bone abscess.

Verified May 8, 2026 · 7 sources ↓

Medicare: $563.47
Work RVU: 7.46
Global, days: 90
Region: Wrist

Drawn from CMSAAPCAbosBedrockbillingCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify the bone(s) involved by name (radius, ulna, carpal bone) — vague 'forearm bone' references draw audit flags.
Document the depth of incision explicitly confirming cortical penetration, distinguishing this from soft-tissue-only drainage.
Record the clinical indication driving cortical incision: imaging or intraoperative findings confirming osteomyelitis, abscess, or equivalent pathology.
Include the laterality (left vs. right forearm/wrist) in both the operative note and diagnosis coding.
Document operative findings — presence of purulence, necrotic bone, cultures obtained — to support medical necessity under payer review.
If modifier 22 is applied, include a separate written explanation of the additional work performed and the circumstances that made it necessary.

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 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 25035 describes a deep surgical incision through the cortex of a forearm or wrist bone to drain infection or decompress a bone abscess — most commonly osteomyelitis. The procedure requires opening the periosteum and bone cortex to access purulent or necrotic material, distinguish it from the shallower soft-tissue drainage codes in the 25028–25031 range.

This carries a 90-day global period, so all routine follow-up visits, wound checks, and dressing changes through day 90 are bundled. Staged or planned return debridements during that window need modifier 58; an unplanned return to the OR for the same infectious process needs modifier 78. Unrelated procedures in the global period need modifier 79.

NCCI bundles 25031 (incision and drainage, forearm/wrist bursa) as a component of 25035. If you bill both on the same date, 25031 will deny unless a modifier is appended and documentation supports a distinctly separate site or encounter. Modifier 59 or XS is the appropriate bypass when anatomically justified.

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 (7.46) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (16.87) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.46
Practice expense RVU	7.82
Malpractice RVU	1.59
Total RVU	16.87
Medicare national rate	$563.47
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	$563.47
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 25035 get rejected.

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

Missing laterality — claims without LT or RT modifier are routinely rejected by Medicare and many commercial payers.
Bundling denial when 25031 is billed same-day without a modifier and documentation of a distinct anatomic site.
Medical necessity denial when imaging or clinical documentation does not corroborate cortical bone involvement versus superficial abscess.
Global period violation — follow-up E/M billed within the 90-day window without modifier 24 to establish an unrelated condition.
Incorrect depth documentation — operative note describes a soft-tissue incision only, inconsistent with the cortical-incision code billed.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What separates 25035 from 25028?

25028 is incision and drainage of a deep soft-tissue abscess or hematoma in the forearm or wrist — it does not involve the bone cortex. 25035 requires surgical opening of the bone cortex itself. If your operative note doesn't explicitly document cortical penetration, expect a downcode to 25028.

02Can I bill 25035 and 25031 on the same date?

NCCI bundles 25031 into 25035 as a less-extensive procedure. You can append modifier 59 or XS to 25031 only if a genuinely separate anatomic site (e.g., a distinct bursa remote from the bony incision site) was treated and documentation supports it. Same-site billing of both codes will deny.

03What modifier do I use if the patient returns to the OR during the 90-day global for further debridement of the same osteomyelitis?

Use modifier 78 for an unplanned return to the OR for a procedure related to the original surgery during the global period. If the return was planned and staged from the outset, modifier 58 is correct — it also resets the global clock.

04Is modifier 50 appropriate for bilateral forearm osteomyelitis treated in one session?

Yes. If both forearms are surgically entered in the same operative session, append modifier 50 to 25035. Most Medicare contractors reimburse bilateral procedures at 150% of the single-procedure allowable. Bill as a single line with modifier 50.

05Does 25035 require an ICD-10 code for osteomyelitis, or can it be billed for a bone abscess without a confirmed infection code?

The procedure code is clinically indicated for both osteomyelitis and bone abscess. ICD-10 codes for acute osteomyelitis (M86.0x–M86.1x series), chronic osteomyelitis (M86.4x–M86.6x), and bone abscess (M86.8x) all map appropriately. Confirm payer-specific crosswalk requirements — some MACs flag claims where the diagnosis code specificity doesn't match the site documented in the operative note.

06How does the 90-day global period affect E/M billing after surgery?

All routine post-op E/M visits within 90 days are bundled into 25035. To bill a separately payable E/M during the global, append modifier 24 and document that the visit addressed a condition entirely unrelated to the osteomyelitis or its surgical management. Modifier 57 applies to an E/M at which the decision for surgery is made, billed the day of or day before the procedure.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the bone(s) named intraoperatively, the surgeon's confirmation of cortical penetration, laterality, and the pathological findings (purulence, necrotic bone, culture swabs). That specificity closes the documentation gap that drives medical-necessity denials and prevents the operative note from being read as a soft-tissue drainage procedure — the most common reason 25035 gets downcoded to 25028.

See how Mira captures CPT 25035 documentation