Tenodesis at the wrist anchoring the flexor tendons of the fingers to bone to restore hand motion and wrist stability.

Verified May 8, 2026 · 6 sources ↓

Medicare: $656.33
Work RVU: 8.79
Global, days: 90
Region: Wrist

Drawn from CMSBedrockbillingAbosFastrvuMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative note must identify the specific tendon(s) involved by name (e.g., flexor digitorum profundus, flexor digitorum superficialis) — 'flexor tendons' alone is insufficient.
Document the fixation method used to anchor tendon to bone (e.g., suture anchor, bone tunnel, tenodesis screw) and the specific wrist bone used as the anchor site.
Record the clinical indication explaining why tenodesis was chosen over repair or transfer, including the underlying diagnosis (paralysis, avulsion, spasticity, etc.).
Pre-operative and intra-operative findings should confirm irreparable or functionally inadequate distal tendon or muscle, justifying tenodesis rather than primary repair.
If modifier 22 is appended, document specific factors that made the procedure significantly more complex than typical — adhesions, prior surgery, anatomic distortion — with estimated time comparison.

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 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side 24 Unrelated E/M during global

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25300 covers tenodesis at the wrist targeting the flexor tendons of the fingers — specifically the surgical anchoring of flexor tendons to bone at the wrist to re-establish functional hand motion. This is distinct from tendon transfer (25310) or tendon repair (25260–25274); the defining feature is fixation of the tendon to bone at the wrist level, not simply suturing tendon to tendon or lengthening. Indications include irreversible muscle paralysis, tendon avulsion with insufficient distal stump, or spastic conditions where passive tenodesis effect is surgically reinforced.

The code carries a 90-day global period. All routine follow-up, splint adjustments, and wound checks through day 90 are bundled — bill separately only for unrelated problems (modifier 24) or a new, unrelated procedure (modifier 79). If a related, unplanned return to the OR occurs within the global, modifier 78 applies. With 1,055 NCCI edits on record (1,039 as the Column 1 comprehensive code), bundling exposure is high; confirm CCI pairs before adding ancillary codes to the same claim.

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 (8.79) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (19.65) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.79
Practice expense RVU	8.99
Malpractice RVU	1.87
Total RVU	19.65
Medicare national rate	$656.33
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	$656.33
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 25300 get rejected.

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

Operative note describes 'tendon fusion' generically without naming the specific flexor tendon(s) anchored, causing medical necessity failure on review.
Code billed as tendon repair (25260–25274 range) by payer system due to ambiguous documentation that does not distinguish tenodesis-to-bone from tendon-to-tendon suture.
Ancillary codes bundled under the 1,039 NCCI Column 1 edits submitted without a valid modifier, triggering automatic denial of the secondary line.
Post-operative services billed without modifier 24 or 79 during the 90-day global period, denied as included in the global surgical package.
Bilateral claim submitted without modifier 50 (or LT/RT on separate lines for ASC), causing unit-of-service error and partial or full denial.

Frequently asked questions

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

01What is the difference between CPT 25300 and 25301?

25300 is tenodesis of the flexor tendons of the fingers at the wrist. 25301 covers the same procedure on the extensor tendons. The distinction is in the tendon group — bill based on which tendon system was anchored to bone, and document accordingly.

02Can 25300 and 25310 be billed together on the same day?

Not without a modifier. 25310 (tendon transfer/transplantation) and 25300 are distinct procedures, but NCCI edits are extensive for 25300 as Column 1. Check the specific pair before billing both; if the tendon transfer is at a separate anatomic site or on a clearly distinct tendon, modifier 59 or XS may allow separate reporting.

03Does CPT 25300 have a global period, and what does that mean for post-op billing?

25300 carries a 90-day global period. Routine follow-up, wound care, splinting, and suture removal during those 90 days are bundled into the surgical payment. Use modifier 24 for E/M visits unrelated to the surgery, modifier 78 for an unplanned return to the OR for a related complication, and modifier 79 for a separate unrelated procedure.

04When is modifier 22 appropriate for CPT 25300?

Use modifier 22 when the procedure required substantially more work than typical — documented examples include dense adhesions from prior surgery, aberrant anatomy, or significantly prolonged operative time. Attach a cover letter to the claim explaining the added complexity. Without supporting documentation, payers routinely ignore modifier 22 and pay at the base rate.

05How should a bilateral wrist tenodesis be billed?

In a physician/facility setting, append modifier 50 to a single line for 25300. In an ASC, bill two separate lines — one with modifier LT and one with modifier RT — each with one unit of service. CMS NCCI policy specifies this ASC distinction explicitly.

06Is CPT 25300 typically performed in an ASC or hospital outpatient setting, and does it affect payment?

25300 is performed in both settings. The site of service significantly affects payment — see the Site of Service comparison table on this page. Physician work RVU is the same regardless of site, but the facility fee differs materially between HOPD and ASC rates.

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 specific flexor tendon name(s), the bone anchor site, and the fixation technique directly from surgeon dictation — the three elements auditors most commonly flag as missing. That detail closes the gap between a generic 'tenodesis performed' note and one that survives a medical necessity review or RAC audit without a physician query.

See how Mira captures CPT 25300 documentation