Primary repair of a single flexor tendon or muscle in the forearm or wrist, performed shortly after traumatic injury.

Verified May 8, 2026 · 6 sources ↓

Medicare: $599.21
Work RVU: 7.84
Global, days: 90
Region: Wrist

Drawn from CMSAAPC

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 tendon(s) or muscle(s) repaired by name (e.g., flexor digitorum profundus, flexor pollicis longus)
State the mechanism and timing of injury to support 'primary' repair classification
Describe the repair technique — direct end-to-end suture, core suture configuration, epitendinous repair — not just 'tendon repair performed'
Record suture material and caliber used for each repaired structure
Document wound extension if the original laceration was enlarged for operative access
Note laterality (right vs. left forearm/wrist) in both the operative note and on the claim

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 59 Distinct service 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 25260 covers open primary repair of a flexor tendon or muscle in the forearm and/or wrist — one tendon or muscle per unit — performed in the acute setting following traumatic injury. "Primary" is the operative word: this code applies when repair happens close to the time of injury, before tissue retraction and scarring complicate reconstruction. If repair is delayed and requires a graft, step up to 25265.

The 90-day global period means wound closure, exploration of the operative field, and routine post-op care are all bundled. Don't separately bill complex wound repair codes (e.g., 13121) alongside 25260 — NCCI Chapter 4 is explicit that wound repair codes 12001–13153 cannot be reported separately when the primary procedure carries a 000, 010, 090, or MMM global indicator. The same bundling logic applies to 20103 (wound exploration): if exploration leads directly to the tendon repair, 20103 is not separately payable.

Each additional tendon repaired at the same session is reported with a separate unit of 25260 plus modifier 59 to establish distinct procedural identity — or consider whether 25261 (secondary repair, single tendon) or another code in the 25260–25274 range better describes subsequent tendons by timing and technique. Document tendon name, injury mechanism, timing from injury, repair technique, and suture type for each repaired structure.

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 (7.84) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.94) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.84
Practice expense RVU	8.59
Malpractice RVU	1.51
Total RVU	17.94
Medicare national rate	$599.21
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	$599.21
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 25260 get rejected.

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

Wound closure (e.g., 13121) billed separately — bundled into 25260 per NCCI global surgery policy
Wound exploration (20103) billed alongside 25260 when exploration led directly to the tendon repair
Missing laterality modifier (LT or RT) causing payer-side ambiguity or duplicate-claim edits
Insufficient documentation of 'primary' timing — payer downcodes or denies when operative note doesn't establish repair occurred close to the injury date
Multiple tendons reported as a single unit of 25260 without modifier 59 to distinguish separate structures

Frequently asked questions

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

01What makes a repair 'primary' for 25260 vs. requiring 25265?

25260 is for acute repairs performed shortly after the traumatic injury, before significant tissue retraction or scarring. 25265 applies when repair is delayed and a tissue graft is required. If you're using graft material, you're in 25265 territory.

02Can I bill 13121 for complex wound closure when I also bill 25260?

No. NCCI Chapter 4 bars separate reporting of wound repair codes 12001–13153 for any procedure carrying a 090 global period. The closure is bundled. Your surgeon's history of billing it separately doesn't override the edit.

03If the surgeon repaired three flexor tendons in the same forearm, how many units of 25260 do I report?

Report one unit per tendon repaired. Add modifier 59 to distinguish each additional tendon as a separate procedure. Confirm each tendon is named individually in the operative note — a generic count won't survive audit.

04Is 20103 (wound exploration) separately billable when it leads to a 25260 repair?

No. When exploration of a penetrating wound leads directly to the tendon repair, 20103 is not separately reportable alongside 25260. The exploration is integral to the repair procedure.

05Does 25260 require a specific site-of-service setting?

25260 can be performed in a hospital outpatient department or ASC. Site-of-service affects payment — see the HOPD vs. ASC payment comparison on this page. The code itself has no site restriction, but the 90-day global applies regardless of setting.

06When should modifier 22 be used with 25260?

Use modifier 22 when documented circumstances substantially increase intraoperative work — severe scarring from a prior injury, neurovascular involvement complicating access, or markedly retracted tendon ends requiring unusual technique. Documentation must quantify the added time and complexity; a brief note won't hold up to audit.

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 tendon name, injury date, repair timing classification (primary), operative approach, suture technique, and suture material from dictation for each structure repaired. That prevents the most common audit flag on 25260 — an operative note that says 'flexor tendon repair performed' without naming the specific tendon or establishing that repair occurred in the primary (acute) window.

See how Mira captures CPT 25260 documentation