Surgical lengthening or shortening of a single flexor or extensor tendon in the forearm or wrist — billed per tendon.

Verified May 8, 2026 · 7 sources ↓

Medicare: $532.41
Work RVU: 7.21
Global, days: 90
Region: Wrist

Drawn from CMSAAOSJhsgoAAPCEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Identify each tendon by name (e.g., FDS, FDP, ECRB) — 'forearm tendon' alone is insufficient for audit defense.
Specify whether lengthening or shortening was performed, and the technique used (e.g., Z-plasty, step-cut).
Document the surgical indication: prior failed repair, spasticity, contracture, or other cause driving revision.
Record laterality (left vs. right wrist/forearm) to support LT/RT modifier use.
Note intraoperative findings that distinguish this procedure from tenolysis (25295) or tenotomy (25290), especially if both were considered.
For multiple tendons billed on the same date, the operative note must clearly delineate work performed on each tendon individually.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service 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 7 cited references ↓

CPT 25280 covers open surgical revision of a wrist or forearm tendon — specifically lengthening or shortening of a flexor or extensor tendon — reported per tendon treated. The code sits in the Repair, Revision, and/or Reconstruction section for the forearm and wrist, and it carries a 90-day global period, meaning all routine post-op care through day 90 is bundled. When a surgeon addresses multiple tendons (e.g., both FDS and FDP flexor lengthening), 25280 is reported again for each additional tendon with modifier 51; digit-specific finger modifiers are sometimes appended to distinguish laterality at the digit level, though payer acceptance of those modifiers varies.

The procedure is performed by hand surgeons and orthopedic surgeons and frequently appears in the context of spasticity correction, contracture release, or failed prior repair requiring adjustment. It is distinct from tenolysis (25295), tenotomy (25290), and tendon transfer (25310/25312) — audit teams and NCCI edits routinely flag unbundling of these adjacent codes. CMS data (CMS Physician Fee Schedule 2026) confirms the code carries a significant RVU weight consistent with its operative complexity.

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 (7.21) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (15.94) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.21
Practice expense RVU	7.32
Malpractice RVU	1.41
Total RVU	15.94
Medicare national rate	$532.41
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	$532.41
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 25280 get rejected.

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

Unbundling denial when 25280 is billed same-day with tenolysis (25295) or tenotomy (25290) without documented distinct surgical work on separate tendons.
Missing or vague laterality documentation when LT or RT modifier is absent or conflicts with operative note.
Insufficient medical necessity documentation — payers require a clear indication (e.g., failed repair, spasticity, contracture) beyond a generic tendon diagnosis.
Modifier 51 omitted when multiple tendons are billed in the same session, triggering duplicate-code edits.
Post-op claim denied as bundled into the global period of a prior wrist or forearm procedure without modifier 79 (unrelated) or 78 (related complication return).

Frequently asked questions

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

01Can 25280 be billed more than once on the same operative report?

Yes. The code is per-tendon. Bill 25280 for each distinct tendon lengthened or shortened in the same session, appending modifier 51 to the second and subsequent units. The operative note must separately document the work on each tendon — a single paragraph covering 'multiple tendons' is not enough.

02What is the global period for 25280?

90 days. All routine post-op visits, wound checks, and dressing changes are bundled through day 90. Bill E/M services during that window with modifier 24 only if they address a problem unrelated to the tendon revision.

03How does 25280 differ from 25295 (tenolysis)?

25280 is lengthening or shortening of a tendon — a structural change to the tendon's effective length. 25295 is release of adhesions restricting tendon excursion (tenolysis). NCCI edits will flag both billed together on the same tendon without a distinct operative basis for each.

04When is modifier 22 appropriate for 25280?

When the revision required substantially more work than typical — for example, extensive scarring from prior surgery, complex anatomy from prior trauma, or a significantly prolonged operative time. The operative note must quantify the additional complexity; a boilerplate 'difficult case' comment won't survive audit.

05Does 25280 require modifier 57 if surgery is decided on the same day as the E/M visit?

Yes. If the decision for this 90-day global surgery is made at the same E/M visit, append modifier 57 to the E/M code to avoid the pre-op bundling rules and get the visit paid separately.

06Can 25280 be billed bilaterally?

Bilateral tendon revision in the same session is uncommon but reportable. Use modifier 50 if the identical procedure is performed on both the left and right wrist/forearm. Many payers reimburse the second side at 50% — confirm with your specific contract before assuming full bilateral payment.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the tendon name, direction of revision (lengthening vs. shortening), surgical technique, and laterality directly from dictation — for every tendon addressed. That specificity prevents the most common 25280 audit flag: an operative note that names a procedure category but not the individual structure. When multiple tendons are revised, the scribe logs each separately so per-tendon billing with modifier 51 is supported without a documentation gap.

See how Mira captures CPT 25280 documentation