Excision of a deep (subfascial or intramuscular) soft tissue tumor of the forearm or wrist area, where the tumor plus required margin measures 3 cm or greater at the time of excision.

Verified May 8, 2026 · 6 sources ↓

Medicare: $508.03
Work RVU: 6.95
Global, days: 90
Region: Wrist

Drawn from FacsCMSFastrvuFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Tumor size documented as the greatest diameter of the tumor plus the narrowest margin required, measured at time of excision — not from pre-op imaging
Depth confirmation: operative note must state the tumor was subfascial or intramuscular, not subcutaneous
Anatomic location specified as forearm and/or wrist — generic 'upper extremity' is insufficient
Pathology specimen submitted and report obtained to support diagnosis code and rule out cutaneous origin
Operative note describes approach, dissection planes entered, and margin assessment — 'standard excision' language without depth detail flags on audit
If malignant: document whether excision was intralesional, marginal, or wide, to support correct code selection between 25073 and 25078

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 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 25073 covers surgical removal of a subfascial or intramuscular soft tissue tumor located in the forearm or wrist when the specimen size — tumor plus the narrowest margin needed for complete excision — is 3 cm or greater. Size is measured at the time of excision, not from imaging. The depth requirement (below the fascia or within muscle) is what separates this code from subcutaneous forearm tumor excision codes. If the tumor is subcutaneous regardless of size, you're in a different code family.

Code selection hinges on two variables: depth and size. For deep forearm/wrist tumors under 3 cm, use 25076. For radical resection of a malignant forearm/wrist tumor 3 cm or greater, use 25078 — that code applies when an extensive margin of surrounding normal tissue is removed, as in sarcoma surgery. Do not use 25073 for cutaneous-origin lesions like sebaceous cysts; those belong in the 11400–11446 (benign) or 11600–11646 (malignant cutaneous) series.

The 90-day global period means all routine post-op care through day 90 is bundled. Pathology (separate CPT) is always additionally reportable. If a same-day E/M drove the decision to proceed to surgery, append modifier 57 to the E/M. An unplanned return to the OR for a related complication within the global uses modifier 78; an unrelated procedure in the global window uses modifier 79.

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 (6.95) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (15.21) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.95
Practice expense RVU	6.79
Malpractice RVU	1.47
Total RVU	15.21
Medicare national rate	$508.03
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	$508.03
HOPD (APC 5073) Hospital outpatient department	$2,967.63
ASC (PI G2) Ambulatory surgical center (freestanding)	$1,248.36

Common denial reasons

The recurring reasons claims for CPT 25073 get rejected.

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

Wrong code family: cutaneous-origin lesions (e.g., sebaceous cyst, epidermal inclusion cyst) billed with 25073 instead of 11400–11446
Size threshold not met or not documented: tumor-plus-margin measurement absent from operative note, defaulting reviewer to downcode to 25076
Depth not specified in operative note — no explicit statement that dissection was subfascial or intramuscular
Modifier 57 missing when a same-day new-patient or initial E/M led directly to the surgical decision
Pathology not ordered or report not linked, leaving diagnosis code unsupported and creating medical necessity gap

Frequently asked questions

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

01How is tumor size determined for code selection — from MRI or from the OR?

Size is measured at time of excision: the greatest tumor diameter plus the narrowest margin required for complete removal. Pre-op imaging size is not the determining measurement and should not be used as the sole basis for code selection.

02What is the difference between 25073 and 25078?

25073 is excision of a deep benign (or unspecified) soft tissue tumor 3 cm or greater. 25078 is radical resection — removal of the tumor with an extensive margin of surrounding normal tissue, typically for malignant tumors like sarcoma. The operative technique and oncologic intent distinguish them, not size alone.

03Can I bill 25073 for a sebaceous cyst or lipoma just beneath the skin of the forearm?

No. Cutaneous-origin lesions belong in the 11400–11446 series (benign) or 11600–11646 (malignant cutaneous). 25073 requires the tumor to be subfascial or intramuscular — below the fascia.

04Is pathology separately billable when 25073 is performed?

Yes. Surgical pathology is reported with its own CPT code and is not bundled into the global surgical package for 25073. Always submit the specimen and link the pathology report to the claim.

05What modifier applies if I need to return the patient to the OR during the 90-day global for a wound complication related to the original excision?

Use modifier 78 for an unplanned return to the OR for a complication related to the original procedure. Reserve modifier 79 for a separate, unrelated surgical procedure performed during the global period.

06If the tumor measures 2.8 cm but the required excision margin brings the total to 3.2 cm, which code applies?

25073 applies. The threshold is based on tumor-plus-margin at excision, not the tumor in isolation. Document the margin calculation explicitly in the operative note to defend the code.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures tumor depth (subfascial vs. intramuscular), measured size at excision including margin, laterality, and whether the approach required muscle splitting or retraction. That prevents the two most common downcodes: missing depth documentation that triggers a reclassification to subcutaneous, and an absent size-plus-margin measurement that reviewers use to deny the 3 cm threshold.

See how Mira captures CPT 25073 documentation