Open biopsy of superficial soft tissue in the forearm, with tissue submitted for pathologic analysis.

Verified May 8, 2026 · 6 sources ↓

Medicare: $261.86
Work RVU: 1.99
Global, days: 10
Region: Wrist

Drawn from CMSCgsmedicareMdclarityAAPCGomedicalbilling

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Anatomic location of the biopsy site within the forearm (proximal, mid, distal; volar or dorsal)
Depth of dissection confirming superficial soft tissue, not deep to fascia
Clinical indication for biopsy — describe the lesion's characteristics prompting tissue sampling
Laterality documented (left or right forearm) to support LT/RT modifier use
Pathology requisition or report tied to the operative encounter
Technique described: incision approach, tissue removal method, closure

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 58 Staged or related 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 25065 covers an open biopsy of superficial soft tissue located in the forearm. The surgeon incises down to the suspicious tissue, excises a representative sample, and sends it to pathology. This is not an excision of a mass — it is a diagnostic tissue sampling. The 010 global period means the operative day itself and the following 10 days of routine post-op care are bundled into the payment.

The top billing specialties per CMS PUF data are dermatology, internal medicine, and plastic and reconstructive surgery — not orthopedic surgery. Orthopaedic providers bill this code when evaluating indeterminate soft-tissue lesions of the forearm before committing to a definitive excision. If pathology returns and a more extensive resection follows, that subsequent procedure falls outside the 10-day global and is billed separately with modifier 79 if unrelated or modifier 58 if a staged procedure.

Do not confuse 25065 (superficial) with 25066 (deep soft tissue biopsy of the forearm). Depth of dissection must be documented explicitly in the operative note to support whichever code is used. Bundling FNA codes with 25065 for the same lesion at the same encounter is not allowed per NCCI policy.

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 (1.99) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (7.84) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.99
Practice expense RVU	5.57
Malpractice RVU	0.28
Total RVU	7.84
Medicare national rate	$261.86
Global period	10 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	$261.86
HOPD (APC 5072) Hospital outpatient department	$1,687.37
ASC (PI P3) Ambulatory surgical center (freestanding)	$186.97

Common denial reasons

The recurring reasons claims for CPT 25065 get rejected.

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

Depth not specified — payer unable to distinguish 25065 (superficial) from 25066 (deep), triggering downcoding or denial
FNA biopsy coded alongside 25065 for the same lesion at the same encounter — NCCI bundles these; only one biopsy code is payable
Missing or mismatched ICD-10 diagnosis — lesion diagnosis must support the medical necessity of biopsy
Laterality modifier absent when payer requires LT or RT for upper-extremity procedures
E&M billed same-day without modifier 25 when the visit was the decision visit, not a separately identifiable service

Frequently asked questions

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

01What is the difference between CPT 25065 and 25066?

25065 is a superficial soft tissue biopsy — tissue above or within the superficial fascia. 25066 is a deep soft tissue biopsy requiring dissection below the fascia. The operative note must state depth explicitly; 'soft tissue biopsy forearm' without depth language will get scrutinized.

02Can I bill an E&M visit on the same day as 25065?

Only if the E&M was a significant, separately identifiable service beyond the decision to perform the biopsy. Attach modifier 25 to the E&M. Per NCCI policy, the pre-procedure evaluation is included in the minor surgical procedure's payment — modifier 25 is what separates the two.

03If both forearms are biopsied the same day, how do I bill?

Bill 25065 twice with modifier 50 for a bilateral procedure, or with LT on one line and RT on the other — follow your payer's preferred format. Modifier 50 is the standard CMS approach; some commercial payers prefer separate line items with LT/RT.

04Can I bill a FNA code alongside 25065 for the same lesion?

No. NCCI policy explicitly prohibits reporting an FNA code (10004–10012, 10021) with another biopsy code for the same lesion at the same encounter. If the FNA specimen was inadequate and an open biopsy followed, report only one code.

05The global period is 010 — what does that include?

The day of surgery plus 10 postoperative days of routine follow-up are bundled. Wound checks, suture removal, and standard dressing changes in that window are not separately billable. An unrelated procedure in the post-op window needs modifier 79; a staged related procedure needs modifier 58.

06Pathology came back malignant and I need to do a wider excision — how do I bill the follow-on surgery?

If the excision is planned and staged based on the biopsy result, use modifier 58 (staged procedure during the global period). If the excision occurs after day 10, no modifier is needed — you're outside the global window.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the lesion location (proximal/mid/distal forearm, volar/dorsal), depth of dissection relative to fascia, laterality, and the clinical reason tissue sampling was chosen over observation or imaging. That detail prevents the two most common denials: a depth-ambiguous note that triggers a 25066 challenge, and a missing laterality that stalls the claim at the payer's edit.

See how Mira captures CPT 25065 documentation