Surgical anchoring of wrist extensor tendons to bone (tenodesis) to restore hand motion and wrist stability.

Verified May 8, 2026 · 6 sources ↓

Medicare: $599.21
Work RVU: 8.38
Global, days: 90
Region: Wrist

Drawn from CMSGomedicalbillingFastrvuAAPCMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Named tendon(s) involved (e.g., EDC, ECRL, ECU) with confirmation they were fixed to bone
Surgical approach documented by name and incision length (e.g., 7 cm dorsal longitudinal incision)
Fixation technique specified — suture anchor, drill hole, or other method — with tension assessment
Medical necessity narrative: why direct repair was not feasible and why tenodesis was chosen
Pre-op documentation of tendon dysfunction, imaging, or prior failed repair supporting the indication
Any co-procedures performed documented as distinct steps with separate indications if billed separately

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 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 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 6 cited references ↓

CPT 25301 covers a wrist tenodesis procedure in which extensor tendons — most often the EDC — are anchored to bone at the wrist to restore functional motion and stability. The indication is typically irreparable tendon dysfunction from trauma, inflammatory arthritis, or prior failed repair where direct end-to-end reconstruction is not feasible. The procedure is performed through a dorsal wrist incision, with the surgeon identifying the affected tendons, tensioning them appropriately, and fixing them to the carpus or distal radius.

This code carries a 90-day global period. All related post-op E/M visits, wound checks, and dressing changes through day 90 are bundled into the procedure payment. Unrelated E/M visits in that window require modifier 24; unrelated procedures need modifier 79; an unplanned return to the OR for a related complication bills with modifier 78.

NCCI bundles 10+ codes with 25301. Edits with indicator 0 cannot be bypassed. Indicator 1 edits — where the operative note documents a distinct anatomic site or a separate surgical step — can be unbundled using modifier 59 or, preferably, XS. Document the specific tendon(s) involved, the fixation technique, and the surgical approach by name to withstand audit review.

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 (8.38) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.94) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.38
Practice expense RVU	7.93
Malpractice RVU	1.63
Total RVU	17.94
Medicare national rate	$599.21
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	$599.21
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 25301 get rejected.

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

Services not supported by documentation — operative note lacks tendon-specific detail or fixation description
CARC 97 / CO-97 for bundled code billed alongside 25301 without modifier 59 or XS
Post-op E/M billed without modifier 24 during the 90-day global period
Unspecified approach in the operative note triggers medical review and downcoding or denial
Missing pre-operative documentation of tendon dysfunction or failed conservative/surgical management

Frequently asked questions

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

01Can 25301 and a wrist arthroscopy code be billed together on the same date?

Only if NCCI edits permit unbundling. Check the indicator for the specific arthroscopy code paired with 25301. Indicator 1 allows modifier 59 or XS with documentation of distinct anatomical work; indicator 0 cannot be bypassed regardless of documentation.

02Is 25301 appropriate when the surgeon starts with a repair and converts to tenodesis intraoperatively?

Yes — if the final procedure performed is tenodesis (anchoring tendon to bone) rather than tendon-to-tendon repair, 25301 is the correct code. Document the intraoperative finding that necessitated the change in approach. Do not bill the repair code alongside 25301 for the same tendon.

03What modifier applies if this procedure is performed bilaterally in the same session?

Append modifier 50 and bill on a single line, or bill two lines with LT and RT per payer preference. Confirm bilateral policy with each payer before submission — Medicare follows the 150% rule for bilateral surgical procedures.

04How do you handle an E/M visit on the same day as 25301?

A same-day E/M that represents the decision for surgery uses modifier 57. A separate E/M for a truly unrelated problem on the same day uses modifier 25. Do not bill a routine pre-op assessment as a separate E/M — it is bundled.

05What is the global period for 25301 and what does it bundle?

25301 carries a 90-day global. That includes all related post-op office visits, wound care, and routine follow-up through day 90. Bill modifier 24 for unrelated E/M during the global, modifier 78 for an unplanned related return to the OR, and modifier 79 for an unrelated procedure in the same window.

06Which specialties most commonly bill 25301?

Per CMS Physician Utilization File data, hand surgery accounts for the largest share of 25301 claims, followed by orthopedic surgery and general surgery. The code requires specialist-level operative detail; generalist notes without tendon-specific documentation draw higher audit scrutiny.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the named tendon(s) anchored, the dorsal approach with incision length, fixation method and tension set, and the clinical rationale for tenodesis over direct repair — all from dictation. That prevents the most common denial pattern for 25301: operative notes flagged as lacking tendon-specific or technique-specific detail during post-payment audit.

See how Mira captures CPT 25301 documentation