Surgical excision of a primary ganglion cyst at the wrist, either dorsal or volar location, performed as an open procedure.

Verified May 8, 2026 · 6 sources ↓

Medicare: $320.98
Total RVUs: 9.61
Global, days: 90
Region: Wrist

Drawn from CMSAbosEbhmcMdclarityAAPC

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm this is a primary excision, not a recurrent ganglion — recurrence requires 25112
Specify anatomic location: dorsal or volar wrist
Document the stalk excision down to the joint capsule or tendon sheath origin to support complete excision
Note preoperative diagnosis, intraoperative findings, and any pathology specimen submitted
Document absence of prior excision at this site to defend primary vs. recurrent coding
If modifier 22 is appended, the operative note must quantify increased time, complexity, or adhesions encountered

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 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25111 covers open excision of a primary ganglion cyst at the wrist — dorsal or volar. 'Primary' is the operative word: if the cyst has been excised before and recurred, bill 25112 instead. The distinction isn't cosmetic; payers audit for it, and the two codes carry different work values.

The 90-day global period covers all routine post-op care through day 90. An E&M visit during that window for a new, unrelated complaint needs modifier 24. If you're managing an unrelated surgical problem in the global, modifier 79 applies. Don't confuse 25111 with 25110 (excision of a tendon sheath lesion) — those are anatomically distinct structures and common upcoding/downcoding flags.

Site of service matters here. HOPD and ASC payments differ substantially; see the Site of Service comparison on this page. The procedure is typically performed without an assistant surgeon — major payers routinely deny assistant claims for 25111 unless medical necessity is documented.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	3.44
Practice expense RVU	5.51
Malpractice RVU	0.66
Total RVU	9.61
Medicare national rate	$320.98
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	$320.98
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 25111 get rejected.

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

25112 billed as 25111 — or vice versa — when prior excision history is documented
25111 bundled into a same-day more complex wrist procedure without modifier 59 or XS to establish separate service
Assistant surgeon claim denied for lack of documented medical necessity
Missing or inadequate pathology/specimen documentation when payer requires it for excision claims
LT/RT modifier absent when payer requires laterality on all extremity codes

Frequently asked questions

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

01When do I use 25112 instead of 25111?

Use 25112 when the patient has a documented prior excision of a ganglion at the same wrist site. Recurrence after previous surgery is the sole criterion — payers and auditors will cross-reference prior operative reports.

02Can I bill 25111 twice if the surgeon excised both a dorsal and volar ganglion on the same wrist during the same session?

Yes, with modifier 51 on the second procedure. Each cyst is a distinct anatomical site with separate stalk origins, and AAPC forums confirm this is supported coding when the operative note documents two separate incisions and two distinct lesions.

03Does 25111 require bilateral modifier 50 if both wrists are done?

Yes. If a ganglion is excised on each wrist in the same session, report 25111 with modifier 50, or use LT and RT on separate lines per ASC reporting convention. Confirm your payer's preferred bilateral billing method before submitting.

04Is an assistant surgeon billable with 25111?

Generally no — most payers do not allow assistant surgeon reimbursement for 25111 without documented medical necessity. Major reference sources list this procedure as 'No Assist' for standard cases. Document the specific reason if an assistant was required.

05How does the 90-day global affect same-day E&M billing?

Any E&M on the day of surgery is bundled unless it reflects a separately identifiable decision made before the procedure — then modifier 57 applies. Post-op E&M visits related to the ganglion excision are included in the global through day 90. Use modifier 24 only for unrelated conditions managed during that period.

06What distinguishes 25111 from 25110?

25110 is excision of a lesion from the tendon sheath itself — not a ganglion cyst. 25111 is specifically for ganglion cyst excision at the wrist. The pathology and operative anatomy differ; billing one for the other is a common audit target.

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 ganglion location (dorsal vs. volar), confirms primary vs. recurrent status from the clinical history, documents stalk excision to the capsular origin, and flags any intraoperative findings that deviate from routine — like adhesions or unexpected depth. That prevents the single most common denial on this code: 25111 submitted when the patient's record shows a prior excision at the same site, which auditors catch immediately.

See how Mira captures CPT 25111 documentation