Radical resection of a tumor from the radius or ulna, including removal of surrounding tissue as needed to achieve adequate margins.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,329.69
Total RVUs: 39.81
Global, days: 90
Region: Wrist

Drawn from CMSNIHAAOSEatonhand

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 name the specific bone involved (radius vs. ulna) and laterality
Document the tumor type, size, and anatomic location within the bone (diaphysis, metaphysis, epiphysis)
Describe the extent of resection including margin intent and amount of bone removed
Include pre-operative imaging (MRI, CT, or plain film) confirming tumor location and extent
Pathology report confirming specimen submission with gross description and margin assessment
Medical necessity documentation: prior imaging, biopsy results, or oncology referral supporting radical rather than simple excision
Note any reconstruction performed in the same session and code separately if applicable

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 58 Staged or related 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25170 covers radical resection of a primary or aggressive tumor arising from the radius or ulna. This goes beyond simple excision — the surgeon removes the tumor along with a margin of surrounding normal bone and soft tissue. The distinction between excision (25120–25126) and radical resection (25170) is margin intent and extent of bone removal; radical resection implies en-bloc removal with curative or local-control intent, typically for malignant or locally aggressive benign lesions.

The 90-day global period applies. That window covers the operative session, the day-before visit, and all routine follow-up care through day 90. Adjunct services unrelated to the tumor resection — such as management of a comorbid condition — require modifier 24 on any E/M billed in that window. A staged or planned secondary procedure (e.g., reconstructive bone grafting) billed by the same surgeon within the global uses modifier 58. An unplanned return to the OR for a complication related to the original procedure uses modifier 78; an unrelated procedure in the same period uses modifier 79.

Site of service matters. HOPD and ASC reimbursement differ significantly — see the site-of-service comparison table on this page. Most cases are performed in a facility setting. Pathology specimen submission (separate CPT from the 20000s series) is typically billed additionally and is not bundled into 25170, but confirm NCCI edits for any same-session codes before billing.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	21.65
Practice expense RVU	13.55
Malpractice RVU	4.61
Total RVU	39.81
Medicare national rate	$1,329.69
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	$1,329.69
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 25170 get rejected.

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

Insufficient documentation distinguishing radical resection from simple excision — op note lacks margin language or extent of bone removal
Missing or mismatched laterality between claim and operative note, especially without LT or RT modifier
Bundling denials when same-session bone grafting or reconstruction codes are billed without NCCI edit review
Lack of pre-operative imaging or biopsy documentation to support medical necessity for radical approach
E/M billed within the 90-day global without modifier 24, triggering automatic denial

Frequently asked questions

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

01What separates CPT 25170 from CPT 25120 or 25126?

25120 and 25126 cover excision of bone tumors of the radius or ulna (with 25126 adding bone grafting). 25170 is radical resection — en-bloc removal with wide margins, typically for malignant or locally aggressive lesions. The operative note must reflect margin intent and extent to support 25170 over the lower-valued excision codes.

02Does 25170 carry a global period?

Yes — 90-day global. All routine post-op visits, dressing changes, and complication management related to the resection are bundled. Bill modifier 24 on unrelated E/Ms and modifier 58 for planned staged procedures within the global window.

03Can you bill reconstruction or bone grafting separately on the same day?

Potentially yes, but check NCCI edit tables first. If grafting is integral to completing the resection, it may be bundled. If it represents a distinct reconstructive procedure requiring additional work and resources, modifier 59 or XS may apply — document the separate indication clearly.

04When should modifier 22 be used with 25170?

Use modifier 22 when the procedure required substantially more work than typical — for example, unusually large tumor size, complex vascular or nerve involvement, or extensive soft tissue dissection beyond standard. Attach a cover letter quantifying the additional time and complexity. Without supporting documentation, payers will strip the modifier and revert to base reimbursement.

05Is prior authorization typically required for 25170?

Most commercial payers require prior authorization for tumor resection surgery. Submit with supporting imaging, biopsy pathology, and the treating oncologist or surgeon's documentation of medical necessity. Medicare does not require prior auth, but documentation must support medical necessity at post-payment audit.

06How should laterality be reported for 25170?

Append LT or RT to specify the operative side. If bilateral resection occurs in the same session — rare but possible in certain metastatic or systemic conditions — use modifier 50 and document both sides explicitly in the operative note.

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 bone (radius or ulna), laterality, tumor dimensions, margin intent, and extent of bone resection directly from dictation — the exact fields auditors check when distinguishing 25170 from lower-valued excision codes. This prevents downcoding to 25120 or 25126 due to vague operative language.

See how Mira captures CPT 25170 documentation