Open surgical incision of a single flexor or extensor tendon at the forearm or wrist level, performed as a tenotomy procedure.

Verified May 8, 2026 · 7 sources ↓

Medicare: $414.51
Work RVU: 5.29
Global, days: 90
Region: Wrist

Drawn from CMSNIHJhsgoEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Identify the specific tendon(s) by name — flexor or extensor — and anatomic level (forearm vs. wrist)
Confirm the procedure is an open tenotomy (full incision through the tendon), not a percutaneous or endoscopic approach
Document laterality (right or left) explicitly in the operative note and on the claim
Indicate the number of tendons divided; each tendon requires a separate unit of 25290
Record the clinical indication — spasticity, contracture, deformity, or other — and link it to a supporting ICD-10 code
If additional procedures were performed in the same session, document each as a distinct surgical step with separate medical necessity rationale

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 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 25290 covers an open tenotomy of one flexor or extensor tendon in the forearm and/or wrist. The surgeon makes a direct incision to cut the target tendon — distinct from tenolysis (25295, which releases adhesions without cutting through the tendon) and from tendon lengthening or shortening (25280). Code the procedure once per tendon; if multiple tendons are divided in the same session, bill 25290 for each with modifier 51 on the additional units.

The 90-day global period governs all post-op management. Routine follow-up visits, splint checks, and suture removal through day 90 are bundled. Unrelated E/M services in the global window need modifier 24; a significant separately identifiable E/M on the day of surgery needs modifier 25. If the surgeon returns to the OR for an unplanned procedure related to the original tenotomy, append modifier 78. An unrelated return-to-OR procedure within the global takes modifier 79.

Top billing specialties are Hand Surgery, Orthopedic Surgery, and Plastic and Reconstructive Surgery. Laterality modifiers LT/RT are required when the operative site is a paired structure. Confirm site-of-service assignment before billing: HOPD and ASC payment rates differ materially — see the Site of Service comparison table.

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 (5.29) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (12.41) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.29
Practice expense RVU	6.11
Malpractice RVU	1.01
Total RVU	12.41
Medicare national rate	$414.51
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	$414.51
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 25290 get rejected.

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

Missing or incorrect laterality modifier (LT/RT) causes automatic edit failures on many payer systems
Procedure billed as 25290 when documentation supports only percutaneous or minimally invasive technique, which is not covered by this code
Multiple tendons divided but only one unit billed, or units billed without modifier 51 on secondary lines
Bundling conflicts when 25290 is submitted same-day with a related tendon procedure (e.g., 25295) without adequate documentation that each procedure was distinct and separately necessary
Global period violations — post-op E/M claims submitted without modifier 24 or 25, triggering automatic denial

Frequently asked questions

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

01How does 25290 differ from 25295?

25290 is a tenotomy — the tendon is cut through. 25295 is a tenolysis — adhesions are released but the tendon itself remains intact. The operative note must make this distinction explicit; auditors will cross-check the description of findings against the code selected.

02Can I bill 25290 twice if two tendons were cut in the same session?

Yes. Bill one unit of 25290 per tendon divided. Append modifier 51 to the secondary unit(s). Document each tendon by name in the operative report to support multiple units.

03Do I need a laterality modifier on 25290?

Yes. Append LT or RT. Most payer edits and some MACs will auto-deny 25290 without a laterality modifier because the forearm and wrist are paired structures.

04What global period applies to 25290, and what does it include?

25290 carries a 90-day global period. That covers the surgery, the day-before visit if billed, and all routine post-op care through day 90. Splint adjustments, suture removal, and standard wound checks are bundled. Unrelated E/M services in that window need modifier 24.

05Can 25290 and 25295 be billed together on the same day for the same wrist?

Only if different tendons are involved and documentation clearly supports distinct medical necessity for each procedure. NCCI bundling edits may apply; check current NCCI tables and append modifier 59 or XS if the procedures are genuinely separate and distinct.

06Is 25290 subject to SNF consolidated billing?

Yes. CMS includes 25290 in the SNF consolidated billing list, meaning the SNF — not the surgeon — is generally responsible for billing when the patient is in a Part A SNF stay. Verify the patient's SNF status before submitting a professional claim.

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, side (left/right), anatomic level (forearm vs. wrist), and confirmation of open approach directly from dictation. It flags if the operative note describes a percutaneous technique — which wouldn't support 25290 — and prompts the surgeon to specify the number of tendons divided so each unit is billed correctly. This prevents the two most common 25290 denials: laterality errors and single-unit underbilling when multiple tendons are cut in the same session.

See how Mira captures CPT 25290 documentation