Soft tissue repair · Wrist

25115

Surgical excision of a soft-tissue tumor or ganglion arising from the wrist or forearm, including deep subfascial or intramuscular lesions requiring extensive dissection.

Verified May 8, 2026 · 5 sources ↓

Medicare
$703.42
Total RVUs
21.06
Global, days
90
Region
Wrist
Drawn from CMS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

  • Operative report must name the lesion type (e.g., ganglion, lipoma, synovial cyst, fibroma) and confirm pathology specimen submission.
  • Document the anatomic depth: subfascial, intramuscular, or peritendinous — 'deep' alone is insufficient for audit purposes.
  • Identify the specific compartment or anatomic layer entered and any neurovascular or tendon structures encountered during dissection.
  • Record the surgical approach used and the method of lesion removal, including whether the stalk or root was excised to reduce recurrence risk.
  • Include pre-operative imaging interpretation (ultrasound or MRI) that supports the indication and confirms lesion depth when available.
  • Document that the procedure required dissection beyond the subcutaneous layer, distinguishing 25115 from 25111/25112 (superficial 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 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 25115 covers radical excision of a benign tumor or synovial cyst of the wrist or forearm — specifically lesions that require deep dissection beneath the fascia or within muscle. It is not the code for a simple subcutaneous ganglion cyst removal; that work falls under 25111 or 25112. The distinction matters at audit: the operative note must clearly document the depth of dissection, the anatomic compartment entered, and the relationship of the lesion to surrounding neurovascular and tendinous structures.

The 90-day global period absorbs all routine follow-up, wound checks, and suture removals. Any E/M visit for a separate, unrelated problem during that window requires modifier 24. A new problem identified and managed on the same day as surgery requires modifier 25 on the E/M. Per the CMS NCCI Coding Policy Manual, CPT 64719 (ulnar nerve decompression at wrist) is bundled into 25115 and cannot be separately reported.

This code draws from hand surgery, orthopedic surgery, and plastic and reconstructive surgery — all three specialties appear in the CMS Physician Fee Schedule 2026 Physician/Supplier Procedure Summary data. Site of service matters: the HOPD and ASC facility payment rates differ materially (see the Site of Service comparison table). Bill modifier 51 when a second distinct procedure is performed at the same session and 25115 is not the primary code by RVU rank.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU9.84
Practice expense RVU9.34
Malpractice RVU1.88
Total RVU21.06
Medicare national rate$703.42
Global period90 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

SettingMedicare rate (national)
Office (PFS non-facility)
Procedure performed in physician's office
$703.42
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 25115 get rejected.

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

  • Upcoding from 25111/25112: payer downcodes to superficial excision when the operative note lacks explicit documentation of subfascial or intramuscular depth.
  • Bundling denial when 64719 (ulnar nerve decompression at wrist) is billed same-day — NCCI bundles 64719 into 25115 without a modifier override pathway.
  • Global period conflict: E/M services billed within the 90-day global without modifier 24 or 25 are denied as included in the surgical package.
  • Missing pathology report or specimen documentation, triggering medical necessity denials on post-payment audit.
  • Modifier 50 applied incorrectly for bilateral wrist lesion excision without independent operative notes supporting bilateral pathology.

Frequently asked questions

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

01What separates 25115 from 25111 and 25112?
25111 covers excision of a ganglion cyst at the wrist (primary), and 25112 covers recurrent ganglion excision. 25115 applies when the lesion is a benign tumor requiring radical excision — typically subfascial or intramuscular — not a straightforward ganglion. If your operative note describes dissection into or beneath the deep fascia or within a muscle belly, 25115 is correct. If it's a superficial dorsal or volar ganglion excised without entering a deep compartment, 25111 or 25112 applies.
02Can 64719 be billed with 25115 if ulnar nerve neurolysis was performed at the same session?
No. The CMS NCCI Correspondence Language Manual explicitly bundles 64719 into 25115. Billing both on the same date for the same patient will trigger an NCCI bundling denial. The nerve work is considered integral to the surgical package.
03What modifier do I use if a separate, unrelated procedure is performed at the same operative session?
Use modifier 79 on the unrelated procedure if it falls within the 90-day global period of a prior surgery, or modifier 51 if both procedures are performed at the same operative session and 25115 is not the highest-RVU code. Do not use modifier 78 — that applies only to unplanned returns to the OR for a complication related to the original surgery.
04Is modifier 22 defensible for an unusually complex lesion excision?
Yes, but the bar is high. Modifier 22 requires documentation in the operative report of specific factors that substantially increased the work: lesion adherent to major neurovascular structures, unexpected size, significant bleeding requiring additional surgical control, or extended operative time with a clear narrative explanation. A one-line mention of 'difficult dissection' will not survive a payer review.
05How does the 90-day global period affect post-op visits and new problems?
All routine follow-up through day 90 is included. If a patient presents within the global period for a problem completely unrelated to the wrist excision — say, a new knee injury — bill the E/M with modifier 24 and document the unrelated condition clearly. If a new, distinct problem is identified and treated on the day of surgery itself, append modifier 25 to the E/M. Failing to use these modifiers correctly is a reliable path to a global period denial.
06Should I bill LT or RT when operating on a single wrist?
Yes. Appending LT or RT is best practice and required by many payers to establish laterality. For bilateral wrist lesion excisions performed at the same session, use modifier 50 on a single line or bill LT and RT on separate lines per your payer's preference — confirm with each payer, as Medicare and commercial carriers handle this differently.

Sources & references

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

  1. 01CMS Physician Fee Schedule 2026
  2. 02
    cms.gov
    https://www.cms.gov/files/document/medicare-ncci-correspondence-language-manual-02282023.pdf
  3. 03
    cms.gov
    https://www.cms.gov/files/document/2025nccimedicarepolicymanualcompletepdf.pdf
  4. 04
    cms.gov
    https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-faq-library
  5. 05
    cms.gov
    https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits

Mira AI Scribe

The Mira AI Scribe captures the lesion's anatomic depth and compartment from dictation — subfascial, intramuscular, or peritendinous — along with the surgeon's description of neurovascular structures encountered and the completeness of excision including any stalk or root removal. This prevents the single most common denial on 25115: a payer downcode to 25111 because the note said 'wrist lesion excised' without documenting that dissection went beyond the subcutaneous layer.

See how Mira captures CPT 25115 documentation

Related CPT codes

21282 $369.41
Surgical tightening and reattachment of the lateral canthal tendon to restore the outer corner of the eyelid to its correct anatomical position.
27646 $1,389.81
Radical resection of a tumor from the fibula, including removal of wide margins of surrounding normal bone and soft tissue.
26432 $542.76
Closed repair of a finger extensor tendon at its distal insertion — the mallet finger procedure — using splinting with or without percutaneous pin fixation.
27372 $638.96
Surgical removal of a deep foreign body located in the thigh region or knee area, requiring incision through the fascia or into the muscle layer.
Ready?

Ready to transform your orthopedic practice?

See how orthopedic practices are running documentation, billing, and operations on a single voice-first platform.

Get started for free