Surgical removal of a subfascial (intramuscular) soft tissue tumor of the forearm or wrist area measuring less than 3 cm.

Verified May 8, 2026 · 6 sources ↓

Medicare: $490.99
Total RVUs: 14.7
Global, days: 90
Region: Wrist

Drawn from CMSEmednyCgsmedicareNIHEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Tumor depth explicitly documented as subfascial or intramuscular — not simply 'deep'
Measured size of the excised specimen, confirmed at or under 3 cm (pathology report or intraoperative measurement)
Operative note identifies the specific forearm or wrist location and the surgical approach used
Documentation distinguishes the lesion from a subcutaneous mass to support subfascial code selection over 25075
Pathology specimen submitted for analysis, with lab order or requisition in the record
Preoperative imaging or clinical documentation supporting the indication for excision

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 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 25076 covers excision of a deep soft tissue tumor — subfascial or intramuscular — in the forearm or wrist area when the lesion measures less than 3 cm. The subfascial depth is the defining characteristic that separates this code from 25075, which covers subcutaneous tumors of the same size. Because the approach goes beneath the fascia, the procedure demands more dissection and carries greater complexity than a superficial excision.

Size and depth both govern code selection in the forearm tumor family. Use 25073 when the subfascial tumor is 3 cm or greater. Use 25075 for subcutaneous lesions under 3 cm. If imaging suggests a malignant or aggressive lesion requiring wide margins and compartment-level resection, 25077 (radical resection, less than 3 cm) is the appropriate code — not 25076. Selecting the wrong code in that scenario creates both a reimbursement shortfall and an audit exposure.

25076 carries a 90-day global period. All routine post-op care, wound checks, and suture removal through day 90 are bundled. Unrelated procedures performed in that window need modifier 79. If the patient returns for a related complication requiring a second OR visit, use modifier 78. Pathology processing is billed separately; the excision code does not include the lab analysis of the specimen.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.57
Practice expense RVU	6.83
Malpractice RVU	1.3
Total RVU	14.7
Medicare national rate	$490.99
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	$490.99
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 25076 get rejected.

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

Code selected as 25075 (subcutaneous) when operative note supports subfascial depth, or vice versa — depth not clearly documented
Tumor size not documented or ambiguous, triggering downcoding or medical necessity denial
Unbundling pathology processing without a separate lab order on record, flagged by payer audit
Modifier 59 or anatomical modifier missing when billing 25076 alongside another forearm procedure on the same date
Global period conflict — follow-up E/M visit billed without modifier 24 during the 90-day global window

Frequently asked questions

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

01What separates 25076 from 25075?

Depth. 25075 is for subcutaneous tumors under 3 cm. 25076 is for subfascial (intramuscular) tumors under 3 cm. The operative note must explicitly document the subfascial or intramuscular location to support 25076.

02When should 25077 be used instead of 25076?

Use 25077 when the procedure is a radical resection — typically for sarcoma or similarly aggressive lesions requiring wide margins and compartment-level dissection. 25076 is for standard excision of benign or low-suspicion subfascial tumors under 3 cm. Don't use 25076 and expect it to hold up if the path report comes back sarcoma and the operative note describes radical resection.

03Can 25076 be billed bilaterally?

Yes. If subfascial forearm tumors are excised on both arms in the same operative session, append modifier 50. Bill as a single line. Medicare reimbursement for bilateral procedures does not exceed 150% of the single-procedure allowable.

04Is pathology billed separately from 25076?

Yes. 25076 covers the excision only. The laboratory analysis of the excised specimen is billed separately under the appropriate anatomic pathology code. Ensure a separate lab order is in the record to support that line.

05How do you handle a same-day E/M with 25076?

If a separate, significant evaluation is performed on the same day as the excision — for a distinct reason — append modifier 25 to the E/M code. The decision to perform the surgery made at that same visit does not by itself justify a separately billable E/M unless documented as medically distinct.

06What modifier applies if the patient returns to the OR for a wound complication during the 90-day global?

Modifier 78 — unplanned return to the OR for a procedure related to the original surgery during the global period. Do not use modifier 79, which is for unrelated procedures in the global window.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures subfascial depth confirmation, intraoperative or specimen measurement, the specific forearm or wrist location, and the surgical approach from the operative dictation. It flags notes that record depth only as 'deep' without specifying subfascial or intramuscular — the ambiguity that most commonly triggers a downcode to 25075 or a medical necessity denial on audit.

See how Mira captures CPT 25076 documentation