Excision or curettage of a bone cyst or benign tumor from the carpal bones, with defect repair using allograft material.

Verified May 8, 2026 · 6 sources ↓

Medicare: $483.31
Work RVU: 5.99
Global, days: 90
Region: Wrist

Drawn from CMSNIHAAOSAMAEatonhand

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 — do not document 'wrist lesion' without anatomic specificity
Confirm lesion type (bone cyst vs. benign tumor) and include pathology report or intraoperative diagnosis
Document that allograft was used, including graft source and approximate volume packed into the defect
Record the surgical approach and exposure method used to access the carpal bones
Note any increased complexity — extensive tumor involvement, prior surgery, or abnormal anatomy — if modifier 22 is considered
Include imaging (X-ray, CT, or MRI) in the pre-op workup to support medical necessity

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 25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 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

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25136 covers surgical removal or curettage of a bone cyst or benign tumor arising from the carpal bones of the wrist, where the resulting bony defect is filled with allograft (donor bone). The allograft component is integral to this code — if the graft is autograft, verify the correct code in the 25130–25136 family. Per NCCI policy, separately billing a graft harvest code (e.g., 20900–20924) is not permitted when graft procurement is already embedded in the procedure descriptor.

This carries a 90-day global period, meaning all routine post-op care from the day before surgery through day 90 is bundled. An E/M billed during that window for a reason unrelated to the wrist excision needs modifier 24. If the decision for surgery was made at the same visit as a significant, separately identifiable E/M on the day of or day before surgery, append modifier 57 to the E/M — not modifier 25, which is reserved for same-day procedures, not major surgical decisions.

Site of service matters significantly here: HOPD and ASC payment rates differ substantially (see the Site of Service comparison table). Document the lesion type, carpal bone involved, graft source and volume, and any intraoperative complications to support the record if modifier 22 is warranted for substantially increased work.

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 (5.99) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (14.47) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.99
Practice expense RVU	7.2
Malpractice RVU	1.28
Total RVU	14.47
Medicare national rate	$483.31
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	$483.31
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 25136 get rejected.

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

Separate billing of a graft harvest code (e.g., 20900–20902) alongside 25136 — graft is bundled per NCCI policy
Mismatched ICD-10 diagnosis code that does not confirm a carpal bone cyst or benign tumor (e.g., using a soft-tissue or tendon code)
Missing or inadequate pathology documentation to support medical necessity of excision with grafting
E/M billed same-day during the 90-day global without modifier 24 to establish it as unrelated
Billing modifier 22 without operative note language that quantifies the substantially increased work

Frequently asked questions

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

01What is the difference between CPT 25130, 25135, and 25136?

All three cover excision of a bone cyst or benign tumor of the carpal bones. 25130 is excision alone with no graft. 25135 adds autograft (bone harvested from the same patient). 25136 uses allograft (donor bone). The graft type documented in the operative note determines which code applies — defaulting to 25130 when a graft was placed is an undercoding error.

02Can I separately bill a bone graft harvest code (20900–20902) with 25136?

No. Per CMS NCCI policy, when graft procurement is included in the primary procedure descriptor, a separate graft harvest code cannot be reported. The allograft is already bundled into 25136.

03Does modifier 50 apply if both wrists are operated on at the same session?

Yes. If the procedure is performed bilaterally in the same operative session, append modifier 50 to 25136. Some payers require LT and RT on two separate line items instead — verify the specific payer's billing preference before submitting.

04What global period applies to 25136 and what does it include?

25136 carries a 90-day global period. That covers the day-before visit, the surgery itself, and all routine post-op care through day 90 — including office visits, dressing changes, and suture removal. Anything unrelated to the wrist excision billed in that window needs modifier 24 on the E/M.

05When should modifier 22 be appended to 25136?

Use modifier 22 when the operative work is substantially greater than typical — for example, extensive tumor invasion into adjacent carpal bones, prior failed surgery creating a scarred field, or abnormal anatomy requiring significantly more time and effort. The operative note must explicitly describe what made the case harder and quantify the additional work. A vague note will not hold up on audit.

06How does site of service affect reimbursement for 25136?

HOPD and ASC payment rates differ substantially for this code. See the Site of Service comparison table on this page. If the procedure can be safely performed at an ASC rather than a hospital outpatient department, the facility payment difference is significant — relevant for any practice evaluating surgical venue decisions.

07What ICD-10 diagnoses support 25136?

The diagnosis must reflect a bone cyst or benign bone tumor of the wrist or carpal bones. Codes in the M85 range (bone cysts) and D16.1x (benign neoplasm of short bones of upper limb) are typical. A soft-tissue or tendon diagnosis code mismatched to this bone-specific CPT is a top denial trigger.

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, allograft details (source and volume), and surgical approach directly from dictation. This prevents the two most common audit flags for 25136: vague anatomic documentation ('wrist lesion' without bone identification) and missing graft specificity that payers use to question whether allograft was truly performed or to attempt downcoding to 25130.

See how Mira captures CPT 25136 documentation