Excision or curettage of a bone cyst or benign tumor of the radius or ulna, excluding the head or neck of the radius and the olecranon process of the ulna.

Verified May 8, 2026 · 6 sources ↓

Medicare: $475.29
Work RVU: 6.11
Global, days: 90
Region: Wrist

Drawn from AAPCEmednyCMSFindacodeAbos

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify exact anatomic location: radius or ulna, with segment (e.g., distal radius, mid-ulna) — and confirm exclusion of radial head/neck and olecranon
Document lesion type (bone cyst vs. benign tumor) and any imaging correlation (X-ray, MRI, CT) supporting the diagnosis
Operative note must state whether curettage alone or complete excision was performed, and whether bone grafting was required
Confirm pathology specimen was submitted and document intraoperative decision to send tissue for histologic analysis
If billing 25125 or 25126 instead, document graft type and harvest site (autograft) or allograft source separately
ICD-10 diagnosis code must align with a benign lesion — malignant or uncertain-behavior diagnoses require different coding pathways

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 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25120 covers surgical removal or curettage of a benign osseous lesion — cyst or tumor — located in the radius or ulna distal to the elbow, with two anatomic exclusions: the head and neck of the radius, and the olecranon process of the ulna. The procedure involves incision, exposure of the affected bone segment, and excision or curettage of the lesion. When the defect requires bone grafting, step up to 25125 (autograft, graft harvest included) or 25126 (allograft) — those are distinct codes, not add-ons.

The 90-day global period means all routine follow-up through day 90 is bundled. Fracture care, hardware removal, or treatment of a new unrelated condition during that window requires modifier 79. An unplanned return to the OR for a complication related to the original excision uses modifier 78. Pathology specimen submission is common with these cases — make sure the operative note names the lesion type and confirms the intraoperative decision to send tissue, as payers audit medical necessity against the ICD-10 diagnosis.

Site of service matters significantly here: HOPD and ASC payment rates differ substantially (see the site-of-service comparison table). For bilateral forearm lesions excised in the same session, append modifier 50. Laterality modifiers LT and RT are required by many payers even when bilateral modifier 50 is used.

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 (6.11) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (14.23) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.11
Practice expense RVU	6.92
Malpractice RVU	1.2
Total RVU	14.23
Medicare national rate	$475.29
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	$475.29
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 25120 get rejected.

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

ICD-10 mismatch: malignant or uncertain-behavior diagnosis codes paired with 25120, which is limited to benign lesions
Bundling denial when 25125 or 25126 is billed alongside 25120 — grafting codes are not add-ons, they replace 25120
Missing laterality modifier (LT or RT) required by payer, triggering automated edit rejection
Global period violation: post-op E&M billed without modifier 24 within the 90-day window
Medical necessity denial when pre-operative imaging or clinical documentation does not support surgical excision over observation

Frequently asked questions

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

01Can I bill 25120 and 25125 together for the same lesion?

No. 25125 (excision/curettage with autograft) and 25126 (with allograft) replace 25120 when grafting is performed — they are not add-on codes. Bill only one code based on whether grafting was done and what graft type was used.

02Does 25120 cover lesions on the radial head or olecranon?

No. The code explicitly excludes the head and neck of the radius and the olecranon process of the ulna. Lesions at those sites require a different code. Document the operative site carefully to avoid a mismatched claim.

03What modifier do I use if the patient returns to the OR during the 90-day global for a wound complication?

Use modifier 78 for an unplanned return to the OR for a complication related to the original procedure. Use modifier 79 if the return is for an unrelated procedure. Do not invert these — payers audit modifier 78 vs. 79 usage.

04Is modifier 50 appropriate if I excise lesions from both the radius and ulna in the same session?

Modifier 50 applies to bilateral procedures on the same anatomic structure on opposite sides of the body (right forearm vs. left forearm). Excision of separate lesions on both the radius and ulna of the same arm in the same session is a different scenario — consider modifier 59 or separate line items with documentation supporting distinct procedural services, and verify payer policy.

05What ICD-10 codes are typically paired with 25120?

Common diagnoses include M85.x2x (bone cyst, forearm), D16.0–D16.1 (benign neoplasm of radius/ulna), and M85.42 (solitary bone cyst, forearm). Confirm the ICD-10 reflects a benign finding — uncertain or malignant behavior codes will trigger medical necessity review or denial.

06Can I bill a separate E&M on the same day as 25120?

Only if the E&M is significant and separately identifiable from the pre- and post-operative work of the procedure. Append modifier 25 to the E&M code. The visit cannot consist solely of work inherent to the surgical procedure.

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 bone segment involved (e.g., distal radius vs. mid-ulna), confirms the anatomic exclusions are not operative site, records whether the procedure was curettage or complete excision, and flags whether bone grafting was performed — preventing a 25120 claim from going out when 25125 or 25126 is the correct code. It also pulls laterality and links the operative finding to the pre-op imaging diagnosis, closing the ICD-10 mismatch that drives the most common denial on this code.

See how Mira captures CPT 25120 documentation