Radical resection of a soft tissue tumor (such as a sarcoma) of the forearm or wrist measuring 3 cm or greater, requiring wide-margin excision beyond simple tumor removal.

Verified May 8, 2026 · 5 sources ↓

Medicare: $1,082.19
Total RVUs: 32.4
Global, days: 90
Region: Wrist

Drawn from CMSAbosNIHAAPC

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Tumor size documented in centimeters — must confirm ≥3 cm to support 25078 over 25077
Operative note must specify radical resection with wide margins, not simple or marginal excision
Anatomic depth documented: subfascial or intramuscular location consistent with radical resection approach
Pathology report or pre-operative imaging corroborating malignant or presumed malignant nature (e.g., sarcoma diagnosis)
Laterality documented (left vs. right forearm/wrist) to support LT/RT modifier application
Dictated approach to margin control, including any frozen-section results if obtained intraoperatively

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 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 5 cited references ↓

CPT 25078 covers radical resection — not simple excision — of a soft tissue tumor in the forearm or wrist when the lesion is 3 cm or larger. Radical resection implies wide surgical margins, often inclusive of surrounding uninvolved tissue, and is the appropriate code when the pathology is malignant or presumed malignant (e.g., sarcoma). This distinguishes it sharply from the subfascial excision codes (25073, 25076), which apply to benign or unspecified tumors at similar depths.

The size threshold (3 cm or greater) and the radical nature of the resection together define this code. If the tumor is smaller than 3 cm, use 25077. If the procedure is an excision rather than a radical resection — meaning margins are not aggressively cleared — the correct code is 25073 (subfascial, ≥3 cm) or 25071 (subcutaneous, ≥3 cm). Upcoding from excision to radical resection without pathology-confirmed or clinically justified wide margins is an audit target.

This code carries a 90-day global period. Pre-op visits the day before surgery, the surgery itself, and all routine post-operative care through day 90 are bundled. Separate billing for post-op visits within the global requires modifier 24. Surgical oncology accounts for the largest share of 25078 claims in CMS utilization data, though orthopedic oncologists routinely perform these resections as well.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	17.25
Practice expense RVU	11.26
Malpractice RVU	3.89
Total RVU	32.4
Medicare national rate	$1,082.19
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	$1,082.19
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 25078 get rejected.

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

Tumor size not documented or measured intraoperatively, failing to establish the ≥3 cm threshold
Operative note describes marginal or simple excision rather than radical resection with wide margins — payers downcode to 25073
Missing or delayed pathology report that would confirm malignant histology supporting radical resection
Bilateral modifier 50 applied without documentation that both forearms/wrists were independently treated
Post-operative visits billed within the 90-day global period without modifier 24 indicating unrelated service

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What separates 25078 from 25073?

Intent and margin strategy. CPT 25073 is a subfascial excision of a tumor ≥3 cm — typically benign or unspecified. CPT 25078 is a radical resection with wide margins, indicated when malignancy (e.g., sarcoma) is confirmed or strongly suspected. The operative note must reflect that distinction clearly.

02When should I use 25077 instead of 25078?

Use 25077 when the tumor is a radical resection but measures less than 3 cm. The codes are identical in nature — radical resection with wide margins — and differ only on size threshold. Confirm the measurement from pathology or operative imaging before selecting.

03Can I bill a separate E/M on the same day as 25078?

Yes, if the E/M reflects a significant, separately identifiable service unrelated to the immediate surgical decision. Attach modifier 25 to the E/M. Same-day E/M visits that are entirely about the tumor being resected that day are bundled.

04Does the 90-day global cover reconstruction performed at the same session?

No — if reconstruction (e.g., skin grafting, flap coverage) is performed at the same operative session and represents a distinct service, it can be billed separately with modifier 51. Confirm NCCI bundling via the CMS NCCI edit tables before billing the reconstruction code alongside 25078.

05How do I bill if the surgeon returns to the OR within the global period to address a wound complication from the original resection?

Use modifier 78 for an unplanned return to the OR for a complication related to the original 25078 procedure. The return visit is paid at a reduced rate reflecting only the intraoperative portion, since the global pre- and post-op work is already bundled.

06Is prior authorization typically required for 25078?

Yes — most commercial payers require prior authorization for radical soft tissue tumor resections, particularly when performed in an outpatient hospital or ASC setting. Confirm with the specific payer before scheduling; missing auth is a common reason for non-payment on high-RVU oncologic procedures.

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 size in centimeters, surgical depth (subfascial/intramuscular), margin intent (radical vs. marginal), laterality, and intraoperative pathology findings directly from dictation. This prevents the most common downcode scenario: an operative note that describes the resection without explicitly documenting wide margins and tumor dimensions, which auditors use to reclassify 25078 to a lower excision code.

See how Mira captures CPT 25078 documentation