Excision or curettage of a bone cyst or benign tumor of the carpal bones with autograft; graft harvest is included in the code.

Verified May 8, 2026 · 6 sources ↓

Medicare: $541.09
Work RVU: 6.9
Global, days: 90
Region: Wrist

Drawn from CMSEmednyAAPCAMAFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify the specific carpal bone(s) involved by name (e.g., lunate, scaphoid, capitate) — 'carpal bone' alone is insufficient.
Describe the lesion type (bone cyst vs. benign tumor) and any pre-op imaging that confirms the diagnosis.
Document that autograft was used and record the donor site, volume harvested, and harvest technique — graft harvest is included in the RVU but must be confirmed in the operative note.
State the surgical approach and the method of defect preparation (excision vs. curettage) before graft packing.
Record the pathology specimen submitted and the disposition of excised tissue to support medical necessity.
If a concurrent procedure was performed at the same session, document that it was distinct and not incidental to 25135.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 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 25135 describes surgical removal or curettage of a bone cyst or benign tumor located in the carpal bones, where the resulting defect is filled with an autogenous bone graft. Critically, harvesting the autograft is bundled into 25135 — you cannot separately bill 20900 or 20902 for the graft donor site work. The code sits in a three-code family: 25130 (excision/curettage alone, no graft), 25135 (with autograft), and 25136 (with allograft). Bill the one that matches the intraoperative decision.

The 90-day global period means all routine postoperative management through day 90 is included. If a separate, unrelated procedure is performed during that window, append modifier 79. An unplanned return to the OR for a complication related to the original surgery takes modifier 78. Avoid modifier 51 stacking when combining 25135 with truly distinct same-session procedures — confirm NCCI edit status before adding a second code.

Note that 25135 bundles into 25431 (carpal nonunion repair) per AAOS bundling guidance, so do not bill 25135 separately when it is performed as a component of a carpal nonunion repair. Payer bundling logic varies; Blue Cross NC and similar payers follow CCI but may apply additional proprietary edits, so verify before submitting same-session combinations.

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 (6.9) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (16.2) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.9
Practice expense RVU	7.83
Malpractice RVU	1.47
Total RVU	16.2
Medicare national rate	$541.09
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	$541.09
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 25135 get rejected.

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

Separate billing of bone graft harvest codes (20900/20902) alongside 25135 — graft procurement is already included and will be denied as a duplicate component.
Bundling denial when 25135 is billed with 25431 (carpal nonunion repair) — per AAOS guidance, 25135 is included in the nonunion repair code.
Medical necessity denial when operative report or diagnosis codes do not clearly support a benign tumor or bone cyst of a carpal bone (e.g., ICD-10 specificity missing or inconsistent with wrist anatomy).
Global period denial for post-op E/M visits billed without modifier 24 when the visit is unrelated to the original procedure.
Missing or vague pathology documentation leading payers to question whether the excised lesion meets the code definition.

Frequently asked questions

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

01Is bone graft harvest billable separately when performing CPT 25135?

No. Autograft harvest is explicitly bundled into 25135. Billing 20900 or 20902 alongside it will be denied as a duplicate component of the procedure.

02When should I use 25130 vs. 25135 vs. 25136?

Use 25130 when no graft is placed after excision or curettage. Use 25135 when the defect is filled with autograft (patient's own bone). Use 25136 when allograft (donor bone) is used. The intraoperative decision drives the code — document the graft type explicitly.

03Can 25135 be billed alongside 25431 for carpal nonunion repair?

No. Per AAOS Global Service Data bundling guidance, 25135 is included in 25431. Billing both at the same session will trigger a bundling denial from payers that follow AAOS or CCI-aligned logic.

04How does the 90-day global period affect post-op billing?

All routine follow-up through day 90 is included in the global. Unrelated E/M visits in that window need modifier 24. An unrelated same-period surgery needs modifier 79. A return to the OR for a related complication needs modifier 78.

05Is 25135 ever performed bilaterally, and how should it be billed?

Bilateral carpal lesion excision with autograft on the same date is rare but possible. Bill a single line with modifier 50; reimbursement is capped at 150% of the fee schedule amount under standard bilateral surgery rules.

06What ICD-10 codes most commonly support 25135 medical necessity?

Diagnoses pointing to benign neoplasm of carpal bones or solitary bone cyst of the wrist are the expected supports. Use specific ICD-10 codes that identify the carpal bone involved — unspecified wrist or hand codes increase the risk of medical necessity denials.

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 carpal bone name, lesion type, harvest site, graft volume, and surgical approach directly from dictation for 25135. That prevents the two most common audit flags: an operative note that says 'carpal lesion' without naming the bone, and a missing graft harvest description that makes the 25135 vs. 25130 distinction undefendable on review.

See how Mira captures CPT 25135 documentation