Excision of a soft tissue tumor in the subcutaneous layer of the forearm and/or wrist area measuring 3 cm or greater in greatest diameter plus required margin.

Verified May 8, 2026 · 7 sources ↓

Medicare: $404.48
Work RVU: 5.76
Global, days: 90
Region: Wrist

Drawn from CMSFacsMdclarityAAOSCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Intraoperative measurement of tumor plus required excision margin — state the combined size in centimeters explicitly in the operative note
Confirm tumor depth as subcutaneous (above fascia); distinguish from subfascial to support 25071 over 25073
Anatomic location — specify forearm vs. wrist and laterality (left/right) for modifier LT/RT application
Pathology report correlating with the operative specimen to support medical necessity and confirm diagnosis
Preoperative imaging or clinical documentation of the mass, including duration and any prior treatment, to support medical necessity
If modifier 22 is appended, a separate narrative explaining the substantially increased complexity beyond typical excision work

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 57 Decision for surgery 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 7 cited references ↓

CPT 25071 covers surgical removal of a subcutaneous soft tissue tumor of the forearm or wrist when the tumor plus the margin required for complete excision measures 3 cm or greater. Size is measured at the time of excision as the greatest diameter of the tumor combined with the narrowest margin needed for adequate removal — not the specimen in a jar after fixation. That measurement distinction drives code selection and must be explicit in the operative note.

Code selection hinges on two axes: depth and size. Subcutaneous (25071) means the mass sits above the fascia. If it is subfascial or intramuscular, you're in 25073 territory. The size threshold separating 25071 from its smaller sibling (25070, tumors under 3 cm) is the combined tumor-plus-margin measurement, not the clinical estimate recorded preoperatively. Don't let a preop MRI measurement drive the code when intraoperative measurement tells a different story — document both.

This code carries a 90-day global period. Any E/M visit on the day of or day before surgery where the decision for surgery is made requires modifier 57. Routine postoperative follow-up is bundled through day 90; bill separately only for distinct, unrelated problems using modifier 24. Tumors of cutaneous origin — sebaceous cysts, epidermal inclusion cysts — are not reported here; those belong in the 11400–11446 series. 25071 is for soft tissue tumors of the musculoskeletal subsystem.

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 (5.76) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (12.11) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.76
Practice expense RVU	5.07
Malpractice RVU	1.28
Total RVU	12.11
Medicare national rate	$404.48
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	$404.48
HOPD (APC 5072) Hospital outpatient department	$1,687.37
ASC (PI G2) Ambulatory surgical center (freestanding)	$742.04

Common denial reasons

The recurring reasons claims for CPT 25071 get rejected.

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

Wrong code family: sebaceous cysts and other cutaneous-origin lesions billed under 25071 instead of 11400–11446, triggering payer downcoding or denial
Tumor size not documented intraoperatively — payer cannot verify the 3 cm or greater threshold without a stated measurement in the operative note
Place-of-service mismatch: some payers deny 25071 when billed with a facility POS if the procedure was performed in-office without updated contract language
Missing laterality modifier when payer policy requires LT or RT on unilateral forearm procedures
Depth not specified in operative note, leaving reviewers unable to distinguish subcutaneous (25071) from subfascial (25073)

Frequently asked questions

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

01What is the size threshold that separates 25071 from 25070?

The cutoff is 3 cm measured as the tumor's greatest diameter plus the margin required for complete excision, assessed at the time of surgery — not a preoperative imaging measurement.

02Can 25071 be used for a sebaceous cyst or epidermal inclusion cyst of the forearm?

No. Lesions of cutaneous origin are reported with codes 11400–11446 for benign lesions. CPT 25071 applies to soft tissue tumors of the musculoskeletal subsystem only.

03How do I bill a same-day E/M when I'm making the decision for surgery?

Append modifier 57 to the E/M code. Because 25071 carries a 90-day global, the decision-for-surgery E/M on the day of or day before the procedure requires modifier 57 to be separately payable under Medicare.

04What modifier do I use if this lesion is on the left forearm?

Append modifier LT to 25071. Use RT for the right forearm. If bilateral excisions are performed in the same session, bill 25071-50 or report two line items with LT and RT per payer preference.

05Is 25071 appropriate for a subfascial or intramuscular tumor?

No. If the tumor is below the fascia, report 25073 instead. Depth must be documented in the operative note; auditors look for explicit fascial-layer language, not just the word 'deep.'

06What happens if a related procedure is needed during the 90-day global period?

An unplanned return to the OR for a procedure related to the original excision is reported with modifier 78. If the return procedure is unrelated to the excision, use modifier 79. Do not invert these — 78 is for related, 79 is for unrelated.

07Can 25071 be performed and billed from an office setting?

Yes, though some payers have denied it for place-of-service mismatch. Verify your payer contract allows this code in an office setting (POS 11) and document that appropriate surgical resources were available.

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 intraoperative tumor-plus-margin measurement, depth relative to fascia, and anatomic laterality directly from surgeon dictation. This prevents the most common 25071 audit flag — an operative note that records a preop estimate rather than the intraoperative combined size — and ensures the documentation supports the 3 cm or greater threshold required to distinguish 25071 from 25070.

See how Mira captures CPT 25071 documentation