Excision or curettage of a bone cyst or benign tumor of the radius or ulna (excluding the radial head/neck and olecranon), with autograft repair of the resulting defect.

Verified May 8, 2026 · 5 sources ↓

Medicare: $570.82
Work RVU: 7.48
Global, days: 90
Region: Wrist

Drawn from CMSAAOSFastrvu

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify which bone was operated on (radius or ulna) and the exact location — the operative note must confirm the lesion was not at the radial head/neck or olecranon process.
Document lesion type (cyst vs. benign tumor), size in centimeters, and depth relative to cortical bone.
Describe the autograft harvest site, volume of graft used, and how the defect was reconstructed — bundled harvest cannot be billed separately, but the harvest must still be documented.
Record pre- and post-operative imaging references (X-ray or MRI) confirming lesion location and extent.
If modifier 22 is appended, include explicit narrative in the operative report quantifying the additional time, complexity, or intraoperative findings that exceeded typical case expectations.
Pathology submission and specimen labeling consistent with the operative site — mismatched laterality between the path report and claim is a common audit flag.

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 51 Multiple procedures 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 25125 covers surgical removal of a benign bone lesion — cyst or tumor — from the diaphysis or metaphysis of the radius or ulna, with the critical distinction that the radial head/neck and olecranon process are excluded. The defect left after excision or curettage is filled with autogenous bone graft harvested from another site on the same patient. That graft harvest is bundled into 25125 per NCCI policy: if a tissue transfer or graft procurement is included in the code descriptor of the primary procedure, it cannot be billed separately.

The 90-day global period means all routine post-op visits, wound checks, and graft-site care through day 90 are included. Any service unrelated to the forearm lesion excision during that window requires modifier 24 (E/M) or modifier 79 (unrelated surgical procedure). If the pathology turns out to require substantially greater work than typical — for instance, an unusually large or aggressive lesion with complex reconstruction — modifier 22 is appropriate, but the operative note must explicitly quantify why the work exceeded the norm.

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 (7.48) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.09) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.48
Practice expense RVU	8.02
Malpractice RVU	1.59
Total RVU	17.09
Medicare national rate	$570.82
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	$570.82
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 25125 get rejected.

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

Separate billing of the autograft harvest (e.g., 20900-series codes) — NCCI bundles graft procurement when the descriptor of the primary code includes it.
Lesion site documented as radial head, radial neck, or olecranon, which falls under different CPT codes and triggers a mismatch denial.
Missing or inadequate pathology documentation — payers often require tissue diagnosis to support medical necessity for bone lesion excision.
Modifier 22 submitted without operative note narrative that specifically supports the increased work claim, resulting in downcoding or denial of the modifier.
Post-op E/M billed during the 90-day global period without modifier 24, causing automatic bundling and non-payment.

Frequently asked questions

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

01Can I separately bill the autograft harvest with 25125?

No. NCCI policy states that when a code descriptor includes procurement of a graft, the harvest cannot be reported separately. 25125 includes the autograft; billing a 20900-series code alongside it will be denied.

02Does 25125 apply if the lesion is on the radial head or olecranon?

No. The radial head/neck and olecranon are explicitly excluded. Those sites map to different CPT codes. Document and code to the specific anatomic location or expect a denial.

03What modifier do I use if I perform an unrelated procedure during the 90-day global?

Modifier 79 designates an unrelated procedure by the same surgeon during the global period. Modifier 78 is for an unplanned return to the OR for a complication or directly related issue — do not use 78 and 79 interchangeably.

04When is modifier 22 defensible for 25125?

When the lesion is unusually large, multilocular, or requires complex reconstruction beyond standard curettage and grafting. The operative note must explicitly state why the work exceeded typical — increased time alone is not sufficient justification.

05Is 25125 subject to site-of-service payment differences between HOPD and ASC?

Yes. The HOPD and ASC payment rates differ materially — see the site-of-service comparison table on this page. That differential is relevant for practice administrators deciding where to schedule these cases.

06Do I need modifier 57 when the decision for surgery is made the day before the procedure?

Yes, if you're billing an E/M on the day before or day of surgery. Because 25125 carries a 90-day global, modifier 57 applies to the E/M at which the surgical decision was made, allowing separate reimbursement for that visit.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the bone involved (radius vs. ulna), lesion classification (cyst or benign tumor), anatomic location confirming exclusion of the radial head/neck and olecranon, graft harvest site, defect size, and reconstruction technique from dictation. This prevents the two most common 25125 audit flags: an underdocumented graft narrative that makes bundled harvest look like a separate billable service, and a site description vague enough to support a code-level challenge.

See how Mira captures CPT 25125 documentation