Primary surgical repair of a single extensor tendon or muscle in the forearm and/or wrist, performed acutely following traumatic injury.

Verified May 8, 2026 · 7 sources ↓

Medicare: $470.95
Total RVUs: 14.1
Global, days: 90
Region: Wrist

Drawn from CMSFindacodeAAPCEmednyAxogeninc

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify the tendon(s) repaired by name (e.g., extensor digitorum communis to long finger, extensor pollicis longus) — vague references to 'extensor tendon' are a red flag in audit.
Confirm the repair is primary (acute) — document time from injury to OR, mechanism of injury, and preoperative tendon status.
Record the number of tendons repaired; each tendon supports a separate unit of 25270, so the operative note must individualize each repair.
Laterality must be explicit — 'left forearm' or 'right wrist' — to support LT or RT modifier use.
Document approach, zone of injury, repair technique (e.g., core suture configuration), and postoperative tensioning assessment.
If performed with nerve repair or other concurrent procedures, document that each procedure required distinct surgical work to justify separate billing.

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 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 7 cited references ↓

25270 covers primary repair of one extensor tendon or muscle in the forearm or wrist — performed at the time of injury, before significant scarring or retraction occurs. 'Primary' is the operative word: if the repair is delayed or requires a free graft, step up to 25272 (secondary, no graft) or 25274 (secondary, with free graft). Each tendon repaired is a separately reportable unit, so two extensor tendons repaired through the same incision can be billed as two units of 25270 — but verify payer MUE tolerance before stacking units on a single claim line versus separate lines.

The 90-day global period covers the day before surgery, the operative session, and all routine postoperative management through day 90. Complications requiring unplanned return to the OR for a related procedure use modifier 78. A staged or planned secondary procedure during the global window — say, tenolysis at 25295 — uses modifier 58. Unrelated procedures in the global period need modifier 79.

Distinguish 25270 from the flexor repair family (25260–25265) and from tendon sheath repair (25275). Laterality modifiers LT and RT are standard for forearm procedures; modifier 50 applies when bilateral forearm extensor repairs are performed in the same session.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.02
Practice expense RVU	6.89
Malpractice RVU	1.19
Total RVU	14.1
Medicare national rate	$470.95
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	$470.95
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 25270 get rejected.

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

Units denied because payer MUE is exceeded when multiple tendons are billed as stacked units on a single claim line without documentation supporting each individual repair.
Bundling denial when 25270 is billed same-session with procedures the payer considers inclusive — check NCCI edits for any companion codes billed on the same date.
Missing or ambiguous laterality modifier causes claim rejection or delay on payers requiring LT/RT for extremity procedures.
Claim coded as 25270 but operative note describes a delayed or secondary repair, triggering a mismatch that leads to a medical records request or denial in favor of 25272.
Global period denial when a postoperative visit or related service is billed within the 90-day window without modifier 24 or 78 to indicate it falls outside routine post-op care.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Can I bill 25270 twice for two extensor tendons repaired in the same session?

Yes. 25270 is described per tendon, so two tendons = two units. Some payers accept two units on one claim line; others want separate lines with modifier 59 or XS on the second. Confirm with each payer and ensure the operative note names each tendon individually.

02What is the difference between 25270 and 25272?

25270 is primary repair — performed acutely at the time of injury. 25272 is secondary repair of a single extensor tendon without a graft, used when the repair is delayed or the primary repair failed. Timing and tendon condition documented in the operative note determine which code applies.

03Is modifier 51 required when 25270 is billed with other procedures?

Modifier 51 flags 25270 as a secondary procedure in a multi-procedure session, which typically triggers the multiple-procedure payment reduction. Some payers apply it automatically; others require you to append it. Check payer-specific rules — Medicare generally applies the reduction without requiring the modifier on the claim.

04How do I handle a return to the OR during the 90-day global period?

If the return is for a complication related to the original repair — say, wound dehiscence requiring re-exploration — use modifier 78. If the return is for a planned staged procedure (e.g., tenolysis after healing), use modifier 58. Modifier 79 is for a completely unrelated procedure by the same surgeon during the global period.

05Does 25270 cover extensor tendon repairs at the wrist only, or also in the forearm?

Both. The code explicitly covers primary extensor tendon or muscle repair anywhere in the forearm and/or wrist. Repairs at the fingers fall under different codes (e.g., 26410–26418). Zone and anatomic location documented in the operative note should confirm the repair site is forearm or wrist.

06When should modifier 22 be appended to 25270?

Append modifier 22 when the repair required substantially greater work than typical — for example, severe contamination, significant tendon retraction requiring extended dissection, or complex soft tissue management. You must attach a cover letter quantifying the extra time and complexity; without it, most payers deny the upcharge.

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, zone of injury, repair timing relative to injury, technique, and number of tendons individually repaired from dictation. That detail locks in the 'primary' designation and supports multi-unit billing when more than one extensor tendon is repaired — preventing downcodes to 25272 or bundling denials from underdocumented operative notes.

See how Mira captures CPT 25270 documentation