Extensor tendon sheath synovectomy of the wrist, single compartment, performed together with resection of the distal ulna.

Verified May 8, 2026 · 7 sources ↓

Medicare: $486.65
Work RVU: 6.05
Global, days: 90
Region: Wrist

Drawn from CMSAAPCFindacodeEatonhandAbos

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Identify the specific extensor compartment(s) involved by number or anatomic name — vague terms like 'dorsal compartment' without specificity invite audit queries.
Confirm the extent of distal ulna resection: document amount resected, the technique (e.g., oblique versus flat osteotomy), and the rationale (instability, impingement, arthritic erosion).
Document the disease process driving the synovectomy — rheumatoid arthritis, other inflammatory arthropathy, or infection — with supporting pathology or clinical history.
Note laterality explicitly in the operative report header and body; LT/RT modifier selection must match the documented operative side.
Record intraoperative findings for both the tendon sheath and the distal ulna to support medical necessity for the combined procedure versus synovectomy alone (25118).

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 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 25119 describes a wrist procedure combining two components: synovectomy of the extensor tendon sheath within a single dorsal compartment, and resection of the distal ulna. The surgeon incises to expose the extensor tendons, excises the inflamed synovial lining from the tendon sheath within that compartment, and removes a portion of the distal ulna near the wrist joint. This is the add-on presentation of the base synovectomy — use 25118 when the distal ulna resection is not performed.

The procedure is performed most often in the setting of rheumatoid arthritis, where synovial proliferation and distal ulnar instability or impingement both require surgical management in the same operative session. Because both the soft-tissue and bony components are bundled into 25119, billing 25118 alongside 25119 for the same compartment on the same day will trigger an NCCI edit.

The 90-day global period covers the surgical day plus all related post-op visits through day 90. Separate billing for routine wound checks, dressing changes, or occupational therapy instructions within that window is not payable under the global. Unrelated problems managed in the same post-op period require modifier 24 on the E&M.

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 (6.05) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (14.57) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.05
Practice expense RVU	7.22
Malpractice RVU	1.3
Total RVU	14.57
Medicare national rate	$486.65
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	$486.65
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 25119 get rejected.

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

Bundling denial when 25118 is billed on the same claim for the same compartment and same date — 25119 already includes the synovectomy component.
Medical necessity denial when documentation supports only tenosynovitis without adequate justification for the distal ulna resection component.
Missing or mismatched laterality modifier causing system-level claim rejection or incorrect payment.
Global period violation when post-op E&M visits related to surgical recovery are billed without modifier 24, triggering automatic denial by the payer.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01When do I use 25119 versus 25118?

Use 25119 only when the distal ulna is also resected during the same operative session as the extensor tendon sheath synovectomy. 25118 is the correct code when synovectomy is performed alone without any bony resection. Billing both on the same claim for the same compartment will be denied as a bundle.

02Can I bill 25119 bilaterally?

Yes. If the procedure is performed on both wrists in the same operative session, append modifier 50 and bill a single line, or bill two lines with LT and RT per payer instructions. Some commercial payers and Medicaid programs differ on line-item versus single-line bilateral billing — verify before submitting.

03Is an assistant surgeon billable with 25119?

Assistant surgeon billing (modifier 80 or AS for a PA/NP) is supported by the procedure's complexity, but Medicare and most payers require documentation that assistant surgeon presence was medically necessary. Confirm the payer's assistant-at-surgery policy before billing.

04What ICD-10 diagnoses are most commonly linked to 25119?

Rheumatoid arthritis with wrist involvement is the most common driver. Codes from the M05–M06 range with appropriate wrist site specificity are the standard. Payers expect a diagnosis that explains both the synovitis and the distal ulna pathology — a soft-tissue-only diagnosis without bony involvement can trigger medical necessity denial for the resection component.

05Does the 90-day global cover occupational therapy referrals made post-operatively?

OT services are billed by the therapist under their own codes and are not included in the surgeon's 90-day global. What the global does bundle is any E&M or wound management service the operating surgeon provides that is related to surgical recovery. Unrelated services the surgeon provides in the global window need modifier 24.

06Can 25119 and a separate wrist arthroscopy be billed on the same day?

Potentially, but check the NCCI edits for the specific arthroscopy code you intend to pair it with. If the arthroscopy is in a distinct anatomic area or serves a clearly separate indication, modifier 59 or XS may apply. Document the separate indications explicitly — auditors will look for them.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the specific extensor compartment number, the operative findings in both the tendon sheath and at the distal ulna, the amount of bone resected, and explicit laterality from the surgeon's dictation. This prevents the most common audit flag on 25119: an operative note that documents synovectomy findings thoroughly but fails to support the distal ulna resection as separately necessary, which payers use to downcode the claim to 25118.

See how Mira captures CPT 25119 documentation