Excision or curettage of a bone cyst or benign tumor arising from the carpal bones of the wrist.

Verified May 8, 2026 · 6 sources ↓

Medicare: $430.87
Work RVU: 5.29
Global, days: 90
Region: Wrist

Drawn from CMSAAPCMdclarityCgsmedicareEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative note must identify the specific carpal bone(s) involved by name — e.g., scaphoid, lunate, capitate — not just 'wrist'.
Pathology report confirming benign bone cyst or benign tumor to support medical necessity and ICD-10 diagnosis alignment.
Document surgical approach and extent of excision or curettage, including whether bone grafting or packing was required.
Pre-operative imaging (X-ray, CT, or MRI) in the record to substantiate the osseous origin of the lesion.
If modifier 22 is appended, document specific factors elevating complexity: unusual size, proximity to neurovascular structures, or prior surgery at the site.

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 LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25130 covers open surgical removal or curettage of a bone cyst or benign tumor located in the carpal bones. The surgeon exposes the wrist carpals and excises or curettes the abnormal growth. This is a distinct code from soft-tissue wrist lesion removal — the pathology here is osseous, arising within or directly involving carpal bone structure.

The code carries a 90-day global period. All routine follow-up, dressing changes, and postoperative visits fall inside that window. Separate E/M services during the 90-day global require modifier 24 (unrelated) or modifier 25 (same-day, distinct problem). Any unplanned return to the OR for a related issue in the global period needs modifier 78; an unrelated procedure in that window needs modifier 79.

Hand Surgery is the top billing specialty by Medicare utilization. When performed bilaterally — uncommon but possible — report with modifier 50 on a professional claim or modifiers LT and RT on separate lines for ASC claims, per CMS NCCI Chapter 4 bilateral reporting rules.

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 (5.29) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (12.9) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.29
Practice expense RVU	6.6
Malpractice RVU	1.01
Total RVU	12.9
Medicare national rate	$430.87
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	$430.87
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 25130 get rejected.

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

ICD-10 diagnosis code reflects a soft-tissue or synovial lesion (e.g., ganglion) rather than an osseous cyst or benign bone tumor — use M85.x or D16.x as appropriate.
Missing or insufficient pathology report; payers audit osseous tumor excisions for histologic confirmation of benign nature.
Modifier 22 appended without operative note narrative explaining what made the case significantly more complex than typical.
Bilateral procedure billed without correct modifier (50 on professional claim; LT/RT on separate ASC claim lines), triggering duplicate-service denial.
Global-period E/M billed without modifier 24 or 25, collapsing into the 90-day post-op bundle and denying as included service.

Frequently asked questions

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

01What is the difference between 25130 and soft-tissue wrist lesion excision codes?

25130 is specifically for bone cysts and benign tumors of the carpal bones — the pathology is osseous. Soft-tissue wrist lesion excisions (e.g., ganglion cysts) are reported with different codes. The operative note and pathology report must confirm bony involvement to support 25130.

02Can 25130 be billed bilaterally?

Yes, though uncommon. On a professional claim, append modifier 50 and bill one line. For ASC claims, report two lines with modifiers LT and RT per CMS NCCI bilateral procedure reporting requirements.

03What ICD-10 codes pair with 25130?

Benign bone tumors of carpal bones (D16.12/D16.11 for left/right hand bones) and bone cysts of the wrist (M85.33x series) are the primary diagnosis codes. A soft-tissue or synovial diagnosis will create a CPT-ICD-10 mismatch and likely trigger denial.

04Does the 90-day global include the pathology workup after surgery?

No. Pathology services are never bundled into the surgical global period. Bill pathology review separately. What the 90-day global covers is surgeon E/M visits, routine wound care, and dressing changes directly related to the procedure.

05When is modifier 22 justified for 25130?

Use modifier 22 when the operative note documents factors that materially increased time or complexity — for example, unusually large lesion, multilobar cyst with extensive curettage, or scarring from prior wrist surgery that complicated access. The note must explain the added complexity; an unsupported modifier 22 will be stripped by most payers.

06If the patient returns to the OR during the 90-day global for a wrist complication, what modifier applies?

Modifier 78 for an unplanned return related to the original procedure. Modifier 79 if the new OR procedure is entirely unrelated to the wrist lesion excision. Never invert these — a 78/79 swap is a common audit finding.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the specific carpal bone involved, the nature of the lesion (cyst versus benign tumor), surgical approach, and whether curettage or full excision was performed — exactly the operative detail auditors look for. This prevents downcoding or denial when payers request records to confirm osseous rather than soft-tissue pathology, and flags when modifier 22 language is present in the dictation so the coder can act on it rather than miss it post-submission.

See how Mira captures CPT 25130 documentation