Surgical excision of a lesion arising from a tendon sheath in the wrist.

Verified May 8, 2026 · 6 sources ↓

Medicare: $337.68
Work RVU: 3.94
Global, days: 90
Region: Wrist

Drawn from CMSCgsmedicareEmednyAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative note must name the specific tendon sheath involved and the lesion type (e.g., giant cell tumor of tendon sheath, fibroma).
Pre-operative imaging (MRI or ultrasound) or clinical documentation confirming a discrete tendon sheath lesion, not a diffuse synovitis.
Laterality clearly documented — left or right wrist — to support LT or RT modifier.
Pathology report submitted or ordered to confirm lesion identity; audit teams flag excisions without histologic follow-up.
Document that the excision was of a sheath lesion, not a ganglion, to distinguish from 25111/25112 and justify 25110 selection.
If modifier 22 is appended, the operative note must describe specific factors — dense adhesions, neurovascular proximity, unusual lesion size — that added substantial work beyond typical.

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 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 24 Unrelated E/M during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25110 covers open surgical removal of a lesion — most commonly a giant cell tumor of tendon sheath or similar pathologic mass — originating from the tendon sheath of the wrist. The procedure requires an incision, dissection to the tendon sheath, and excision of the lesion with care to preserve surrounding tendons, neurovascular structures, and joint integrity. It is distinct from ganglion excision (25111/25112) and from radical synovectomy (25115/25116), which involve more extensive sheath resection.

The 90-day global period means all routine follow-up, wound checks, and splint or cast management through day 90 are bundled into the surgical payment. Any visit for an unrelated condition during that window requires modifier 24 on the E/M code. An unplanned return to the OR for a related complication — such as wound dehiscence or recurrent lesion during global — bills with modifier 78. An unrelated procedure performed during the global period uses modifier 79.

Site of service matters here: HOPD and ASC reimbursement differ meaningfully (see the Site of Service comparison table). Many payers require prior authorization and will want imaging or pathology documentation confirming the lesion's nature before approving a facility case. Laterality modifiers LT or RT are required by most payers and by Medicare.

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 (3.94) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (10.11) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	3.94
Practice expense RVU	5.39
Malpractice RVU	0.78
Total RVU	10.11
Medicare national rate	$337.68
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	$337.68
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 25110 get rejected.

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

Missing or ambiguous laterality modifier — Medicare and most commercial payers require LT or RT on wrist procedures.
Upcoded or miscoded as 25111 (ganglion excision) or downcoded to an injection code; operative note must confirm open excision of a sheath lesion.
Lack of pre-authorization for the facility setting, particularly HOPD; many payers require imaging documentation before approving this as a surgical case.
Modifier 78 or 79 missing when procedure falls inside the global period of a prior wrist surgery, causing automatic bundling denial.
Insufficient documentation distinguishing the lesion from diffuse tenosynovitis, leading to medical necessity denial in favor of a synovectomy or conservative treatment.

Frequently asked questions

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

01How does 25110 differ from 25111?

25110 is excision of a lesion from the tendon sheath — think giant cell tumor or fibroma attached to the sheath. 25111 is excision of a wrist ganglion cyst (dorsal or volar), which is a fluid-filled cyst arising from joint capsule or tendon sheath but coded separately. If the operative note says 'ganglion,' use 25111. If it says 'tendon sheath lesion' or 'giant cell tumor,' use 25110.

02Can 25110 and 25111 be billed together on the same day?

Only if the lesions are anatomically distinct — different tendons or separate structures — with documentation supporting each. Append modifier 59 or XS and ensure the operative note clearly describes two separate excision sites. Billing both for what is effectively one lesion will trigger NCCI scrutiny.

03Is modifier 50 appropriate if both wrists are operated on during the same session?

Yes. Bilateral same-session excision bills with modifier 50 appended to 25110. Most payers reimburse bilateral procedures at 150% of the single-procedure rate. Bill on one line with modifier 50; do not bill two separate lines with LT and RT unless a specific payer requires that format.

04What happens if the lesion recurs and needs re-excision during the 90-day global?

If the surgeon returns to the OR unplanned for a recurrence or complication related to the original excision, bill 25110 again with modifier 78. The reimbursement is reduced because modifier 78 applies intraoperative RVUs only — the global period resets from the date of the second procedure.

05Does the 90-day global period cover post-op splinting and therapy referrals?

Splinting applied by the surgeon and routine wound management are bundled into the global. However, formal occupational therapy billed under a separate therapy provider is outside the surgical global and bills independently. Surgeon-billed therapy or casting during the global requires modifier 24 on any associated E/M if the visit is for an unrelated condition.

06When should modifier 22 be used with 25110?

Append modifier 22 when the procedure required substantially greater work than typical — for example, a lesion with extensive tendon adherence requiring meticulous dissection to preserve tendon integrity, or a deeply located lesion near the median or ulnar nerve. The operative note must describe these specific factors in detail; generic language won't survive audit review.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the tendon sheath lesion location (specific tendon named), surgical approach, extent of dissection, neurovascular structures encountered, and the surgeon's confirmation that the lesion arose from the sheath rather than the joint or bone. It also flags laterality for automatic modifier assignment. This prevents the most common denial path: an operative note that says 'wrist mass excised' without specifying the sheath origin, which triggers medical necessity review and frequent downcoding.

See how Mira captures CPT 25110 documentation