Secondary repair of an extensor tendon or muscle in the forearm and/or wrist, performed after the acute injury window has passed, using a free tissue graft harvested from elsewhere on the patient's body — billed per tendon or muscle repaired.
Verified May 8, 2026 · 7 sources ↓
- Medicare
- $615.91
- Total RVUs
- 18.44
- Global, days
- 90
- Region
- Wrist
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 7 cited references ↓
- Specify that repair is secondary (delayed from original injury date) — document time elapsed since injury
- Identify the exact tendon(s) or muscle(s) repaired by anatomical name and compartment
- Document that a free graft was used and identify the donor site and harvest method
- Confirm laterality (left vs. right forearm/wrist) explicitly in the operative note
- Record preoperative diagnosis with supporting imaging or prior treatment history justifying delayed repair
- State the indication for graft (e.g., tendon gap, tissue quality precluding primary repair) — auditors flag notes that omit graft rationale
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 7 cited references ↓
CPT 25274 covers delayed (secondary) surgical repair of a forearm or wrist extensor tendon or muscle when a free graft is required. 'Secondary' means the repair occurs after the primary healing window — not as an acute intervention. The graft harvest is included in the work of this code; don't bill a separate harvest code. Each distinct tendon or muscle repaired is counted separately, so multiple units may apply when more than one structure is addressed in the same session.
This code carries a 90-day global period. All routine follow-up, dressing changes, and post-op visits are bundled through day 90. Anything unrelated to the tendon repair billed in that window requires modifier 24 (E/M) or 79 (unrelated procedure). An E/M on the day of surgery requires modifier 25 only if a separately identifiable, medically necessary decision was made prior to the operative decision.
Site of service matters: HOPD and ASC payments differ substantially — see the Site of Service comparison table. When billing bilateral forearm repairs in the same session, append modifier 50. Use LT/RT when the laterality-specific claims format is required by the payer.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 8.72 |
| Practice expense RVU | 8.08 |
| Malpractice RVU | 1.64 |
| Total RVU | 18.44 |
| Medicare national rate | $615.91 |
| 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 | $615.91 |
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 25274 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing laterality — claim submitted without LT or RT modifier when payer requires anatomical distinction
- Unbundling denial — graft harvest billed separately when it is already included in 25274
- Insufficient documentation of secondary (delayed) nature of repair; note reads like an acute primary repair
- Global period conflict — follow-up E/M billed within 90-day global without modifier 24, triggering automatic bundling
- Units mismatch — single unit billed when multiple tendons were repaired, or multiple units billed without per-tendon documentation supporting each unit
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 7 cited references ↓
01Is the graft harvest separately billable with 25274?
02Can you bill multiple units of 25274 when more than one tendon is repaired?
03What makes this a 'secondary' repair and why does it matter for billing?
04What modifier applies if the same tendon repair needs to be repeated in the 90-day global period due to re-rupture?
05Do you need modifier 51 when billing 25274 with another procedure on the same day?
06When is modifier 22 appropriate for 25274?
07Which ICD-10 diagnoses most commonly support 25274?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/files/document/0-introduction-ncci-medicare-policy-manual-2026-final.pdf
- 03vsac.nlm.nih.govhttps://vsac.nlm.nih.gov/context/cs/codesystem/CPT/version/2019/code/25274/info
- 04mdclarity.comhttps://www.mdclarity.com/cpt-code/25274
- 05aapc.comhttps://www.aapc.com/codes/cpt-codes/25274
- 06findacode.comhttps://www.findacode.com/cpt/25274-cpt-code.html
- 07novitas-solutions.comhttps://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00144519
Mira AI Scribe
Mira's AI scribe captures the secondary repair designation, the specific extensor tendon or muscle name, graft donor site, and elapsed time since original injury directly from dictation. This prevents the most common audit flag on 25274 — operative notes that omit graft rationale or fail to establish the delayed-repair timeline, both of which trigger medical necessity denials.
See how Mira captures CPT 25274 documentation