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), with autograft or allograft repair of the resulting defect.

Verified May 8, 2026 · 6 sources ↓

Medicare: $574.50
Work RVU: 7.55
Global, days: 90
Region: Wrist

Drawn from CMSBedrockbillingFindacodeEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the bone involved (radius or ulna) and confirm the lesion is not at the radial head, radial neck, or olecranon process
Document lesion size, depth, and whether the tumor or cyst was completely excised or curetted
Identify graft type used (autograft with harvest site noted, or allograft with source documented) and confirm graft was placed to fill the osseous defect
Include pre-operative imaging (X-ray, MRI, or CT) confirming a bone cyst or benign tumor diagnosis
Operative note must name the surgical approach and describe the extent of cortical or cancellous involvement — notes that just say 'lesion excised' are audit flags
Pathology submission documentation to support benign tumor or cyst diagnosis and confirm the specimen was sent

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 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 XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25126 covers surgical removal of a bone cyst or benign tumor from the shaft of the radius or ulna, followed by grafting to fill the osseous defect. The graft component — autograft harvested from the patient or allograft from a donor — is integral to the code; you do not separately bill a bone graft harvest code when the graft work is captured here. The exclusion of the radial head, radial neck, and olecranon process is definitional: lesions at those sites use different codes.

This is a 90-day global procedure. Routine post-op visits, wound checks, and cast/splint management through day 90 are bundled. Bill modifier 24 for unrelated E/M visits and modifier 78 for unplanned returns to the OR for a related complication during the global window. Modifier 79 applies to unrelated procedures performed during the global period.

Site of service matters here. HOPD and ASC payments differ substantially — see the Site of Service comparison table. When multiple lesions are excised at distinct anatomic sites on the same forearm bone during the same session, modifier 59 (or the appropriate X modifier) supports separate reporting only when the lesions are genuinely separate, not contiguous structures within the same region.

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 (7.55) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.2) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.55
Practice expense RVU	8.04
Malpractice RVU	1.61
Total RVU	17.2
Medicare national rate	$574.50
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	$574.50
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 25126 get rejected.

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

Lesion location documented at radial head, radial neck, or olecranon process — those sites are explicitly excluded from 25126
Graft type not specified in the operative note, causing downcoding to the without-graft version of the excision
Bundling denial when bone graft harvest is billed separately without documentation that a distinct, additional harvest procedure was performed beyond what 25126 already captures
Missing or mismatched ICD-10 diagnosis code — payers reject claims where the diagnosis doesn't confirm a benign bone lesion (e.g., using a fracture code instead of a neoplasm code)
Modifier 59 used to unbundle a second lesion excision without documentation that the lesions were at anatomically distinct sites, not contiguous structures

Frequently asked questions

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

01Can I separately bill bone graft harvest when performing 25126?

Only if the graft harvest represents work clearly beyond what is integral to the procedure. When the graft fills the defect created by the excision, that work is captured within 25126. A separate harvest code requires documentation of a distinct, additional surgical effort at a different site.

02What modifier do I use if I excise lesions on both the radius and ulna in the same session?

Bill 25126 twice with modifier 51 on the secondary procedure. If both lesions are on the same bone but at anatomically distinct sites, modifier 59 or XS is needed with supporting documentation of separate lesion locations.

03Does the 90-day global include the bone graft follow-up imaging?

Routine post-op visits and wound management are bundled, but imaging ordered to evaluate healing or a complication is typically separately reportable. Document medical necessity clearly for any imaging ordered within the global window.

04A lesion at the radial head needs excision — which code applies?

Not 25126. That code explicitly excludes the head and neck of the radius and the olecranon process. Use the appropriate code for lesion excision at those specific sites; your coding software or NCCI lookup should guide you to the correct alternative.

05Is modifier 50 appropriate if the same benign tumor type appears in both forearms?

Yes, modifier 50 applies for a true bilateral procedure performed in the same session. Confirm with the operative note that both forearms were opened and grafted. Some payers require LT and RT on separate lines instead of modifier 50 — verify payer preference before submitting.

06The patient returns to the OR 3 weeks post-op for wound dehiscence at the graft site — which modifier applies?

Modifier 78 covers an unplanned return to the OR for a complication related to the original procedure during the 90-day global. Do not use modifier 79 here — that is for unrelated procedures only.

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 location relative to excluded anatomic zones (radial head, radial neck, olecranon), graft type and harvest site, lesion dimensions, and the named surgical approach from dictation. This prevents the two most common downcodes: missing graft documentation and failure to confirm the lesion falls within the billable anatomic range of 25126.

See how Mira captures CPT 25126 documentation