Secondary repair of a flexor tendon or muscle in the forearm and/or wrist using a free graft harvested from the patient — performed after the acute injury window has passed.

Verified May 8, 2026 · 6 sources ↓

Medicare: $688.06
Total RVUs: 20.6
Global, days: 90
Region: Wrist

Drawn from CMSAAPCBedrockbillingNIH

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify 'secondary repair' explicitly — note time elapsed since original injury and why primary repair was not performed or failed.
Name the tendon(s) or muscle(s) repaired, including anatomic location within the forearm or wrist.
Document free graft harvest: donor site, graft dimensions, and that harvest was performed by the same surgeon during the same session.
Describe the surgical technique, including approach, preparation of tendon ends, and method of graft fixation.
Include pre-operative imaging or prior operative notes if re-repair after a failed primary repair to support medical necessity.
Record laterality (left or right forearm/wrist) clearly in 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 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

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25265 covers a delayed (secondary) flexor tendon or muscle repair in the forearm or wrist that requires a free tissue graft. The graft harvest is included — do not bill a separate graft procurement code. 'Secondary' is the defining feature: this code applies when primary repair is no longer feasible due to time elapsed since injury, tendon retraction, or prior failed repair. That distinction separates it from 25260 (primary repair, no graft) and 25263 (primary repair with graft).

The 90-day global period starts on the date of surgery. All routine follow-up — wound checks, splint adjustments, suture removal — is bundled. Anything unrelated to the tendon repair billed during that window needs modifier 24 (E/M) or 79 (unrelated procedure). The NCCI edit table for 25265 lists over 1,100 bundled code pairs; most carry modifier indicator 1, meaning a NCCI-associated modifier can unlock separate payment when clinical circumstances justify it.

Site of service matters here: the HOPD and ASC payment rates differ substantially — see the Site of Service comparison table. Document which setting is used and confirm the facility's OPPS or ASC status 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	9.85
Practice expense RVU	8.91
Malpractice RVU	1.84
Total RVU	20.6
Medicare national rate	$688.06
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	$688.06
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 25265 get rejected.

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

Missing 'secondary' qualifier in operative note — payer downcodes to 25260 or 25263 without documentation of delayed timing.
Separate graft harvest code billed alongside 25265 — graft procurement is included in the code and bundles under NCCI.
Laterality not documented — claims without LT or RT modifier flagged or rejected by many payers.
Medical necessity not established — no documentation of why primary repair was not performed or was previously unsuccessful.
Global period violations — follow-up E/M billed without modifier 24, or related procedures billed without modifier 78.

Frequently asked questions

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

01What makes this repair 'secondary' — is there a specific time threshold?

There is no strict day count in the CPT descriptor. 'Secondary' means the repair was not performed acutely at the time of injury — typically because the tendon retracted, the wound was contaminated, the patient presented late, or a prior repair failed. Document the clinical reason for delayed intervention, not just the date gap.

02Can I bill separately for harvesting the graft?

No. The code includes obtaining the free graft. Billing a separate graft harvest code (e.g., 20926, which has a historical NCCI edit against 25265) will be bundled and denied.

03Which modifier do I use if I have to return to the OR for a complication related to the original repair?

Use modifier 78 for an unplanned return to the OR for a complication related to the original tendon repair — for example, re-rupture of the graft. Use modifier 79 only if the return procedure is entirely unrelated to the flexor tendon repair.

04How do I handle bilateral repairs on the same date?

If both forearms or wrists are repaired in the same session, apply modifier 50. Some payers want two line items with LT and RT instead. Confirm payer preference before submitting — Medicare generally accepts modifier 50 on a single line.

05Can I bill an E/M on the same day as 25265?

Only if a separately identifiable evaluation and management service was performed for a reason unrelated to the tendon repair. Attach modifier 25 to the E/M. The global period then covers all routine post-op E/M — use modifier 24 if an unrelated E/M is billed during the 90-day global.

06What ICD-10 diagnosis codes support 25265?

Secondary flexor tendon repairs typically map to codes in the M66 range (spontaneous rupture), S56 range (injury to tendons at forearm level), or T79/T81 codes for post-procedural complications. Use the sequela suffix (seventh character S) when the encounter stems from a prior injury. Payer crosswalk tools confirm accepted pairings.

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 secondary repair designation, tendon or muscle name, graft donor site and dimensions, and laterality directly from the surgeon's dictation. It flags operative notes that omit elapsed time since injury or fail to document graft harvest details — the two most common triggers for downcoding or medical necessity denials on 25265 claims.

See how Mira captures CPT 25265 documentation