Surgical re-excision of a recurrent ganglion cyst at the wrist, either dorsal or volar, after a prior excision has already been performed.

Verified May 8, 2026 · 5 sources ↓

Medicare: $377.10
Work RVU: 4.55
Global, days: 90
Region: Wrist

Drawn from CMSAAPCNIHMdclarityGenhealth

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Confirm prior ganglion excision at the same wrist site — date of prior surgery or reference to prior operative report strengthens the record
Specify cyst location: dorsal or volar wrist
Document intraoperative findings consistent with recurrence: scar tissue, adhesions, altered anatomy
Describe complete stalk dissection to its capsular or tendon sheath origin and confirm full excision
Record anesthesia type and laterality (right vs. left wrist)
Note pre-op symptoms: pain, limited motion, or cosmetic concern, with duration since prior surgery

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 LT Left side RT Right side 78 Unplanned return — related 79 Unrelated during global

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 25112 covers re-excision of a recurrent wrist ganglion cyst — dorsal or volar — in a patient who has had a prior ganglion excision at the same site. The key distinction from 25111 (primary excision) is documented prior surgery. Recurrent ganglions present a more demanding dissection: scar tissue obscures tissue planes, the stalk origin is harder to trace, and complete excision of the stalk to its joint capsule or tendon sheath attachment is essential to reduce the risk of a second recurrence.

The procedure is performed in an outpatient or ASC setting under local or regional anesthesia. The surgeon incises through or around prior scar, dissects the cyst with its stalk, and excises it down to its base. Closure and dressing follow standard soft-tissue technique. The 90-day global period covers all routine post-op care through day 90; any unrelated problem managed in that window requires modifier 24 or 25.

When the operative note lacks clear language confirming prior surgery at the same site, payers will downcode to 25111. Ensure the note explicitly references the patient's surgical history and any intraoperative findings consistent with prior excision — adhesions, scar, or altered anatomy — to support the recurrent designation.

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 (4.55) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (11.29) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.55
Practice expense RVU	5.86
Malpractice RVU	0.88
Total RVU	11.29
Medicare national rate	$377.10
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	$377.10
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 25112 get rejected.

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

Downcode to 25111 when the operative note does not document prior excision at the same site
Laterality missing — payers require LT or RT modifier; claims without it reject on edit
Bundling with same-day soft-tissue procedures where NCCI edits apply and modifier 59 was not appended
Diagnosis code mismatch — submitting a primary ganglion ICD-10 (M67.43x) without supporting history of prior excision triggers review
Missing or insufficient operative note detail; an office-note-level description does not support a 90-day global surgical code

Frequently asked questions

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

01What separates 25112 from 25111?

Prior surgery at the same site. 25111 is primary excision; 25112 is recurrent. The operative note must reference the prior procedure — without it, expect a downcode to 25111.

02Do I need a laterality modifier on 25112?

Yes. Append LT or RT on every claim. Most payers reject wrist procedure claims that omit laterality, and Medicare edits enforce it.

03Can I bill modifier 22 on a particularly difficult recurrent excision?

Yes, if the work was substantially greater than typical — dense scarring, complex anatomy, or significantly prolonged dissection. The operative note must quantify the added difficulty; a generic statement won't survive audit.

04What ICD-10 codes map to 25112?

M67.431 (ganglion, right wrist), M67.432 (left wrist), and M67.439 (unspecified wrist) are the primary diagnostic codes. The recurrent nature is established by history and operative findings, not a separate recurrence-specific ICD-10 code.

05Is 25112 subject to a global period?

Yes — 90-day global. Routine post-op visits, dressing changes, and suture removal through day 90 are included in the payment. Bill modifier 24 for unrelated E/M visits and modifier 79 for unrelated procedures in that window.

06Can 25112 be billed bilaterally in the same session?

Yes. Use modifier 50 for bilateral same-session excision. Both sides must have documented prior excision and current recurrence; bilateral billing on a unilateral finding will be denied.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the prior excision history, cyst location (dorsal vs. volar), laterality, intraoperative findings of scar or adhesion, and confirmation of complete stalk excision to capsular attachment — the exact elements auditors check when 25112 is billed over 25111. Missing any one of these is the most common path to a downcode denial.

See how Mira captures CPT 25112 documentation