Tendon transplantation or transfer in the forearm, flexor or extensor, with tendon graft — graft harvest included, billed per tendon transferred.

Verified May 8, 2026 · 7 sources ↓

Medicare: $664.01
Work RVU: 9.57
Global, days: 90
Region: Wrist

Drawn from CMSAAPCMdclarityFindacodeEmedny

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify whether the tendon transferred is flexor or extensor, and name it explicitly (e.g., extensor pollicis longus, flexor digitorum superficialis).
Identify the donor tendon and harvest site — graft harvest is bundled, but the source must be documented to support the code.
Document the indication: tendon rupture etiology (rheumatoid, traumatic, ischemic), failed primary repair, or functional deficit being restored.
Record the number of tendons transferred — 25312 is a per-tendon code; multiple tendons require separate units with modifier 51.
Describe the surgical approach and technique for both harvest and inset, including fixation method (pullout suture, bone anchor, weave).
Confirm preoperative functional assessment documenting loss of active motion to justify reconstruction over primary repair.

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 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 25312 covers surgical transfer or transplantation of a single flexor or extensor tendon in the forearm and/or wrist, where a tendon graft is harvested and used as part of the reconstruction. The code bundles graft harvest — you do not separately bill for obtaining the graft. Bill one unit per tendon transferred; if multiple tendons are grafted in the same session, each additional tendon may be reported with modifier 51.

This procedure is most commonly performed for tendon rupture from rheumatoid disease, Darrach or Sauvé-Kapandji revisions with extensor tendon loss, Volkmann contracture sequelae, or post-traumatic tendon defects where primary repair isn't feasible. Orthopedic surgery and plastic/reconstructive surgery are the dominant billing specialties. The 90-day global period applies — all routine postoperative hand therapy referrals, wound checks, and splint adjustments through day 90 are bundled. Unrelated procedures in that window need modifier 79; unplanned returns for a related complication need modifier 78.

Site of service matters here: HOPD and ASC facility payments differ substantially (see the Site of Service comparison table on this page). When performed bilaterally — rare, but documented in rheumatoid patients with symmetric rupture — append modifier 50 and bill a single line. Laterality modifiers LT and RT are required by most payers when the procedure is unilateral.

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 (9.57) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (19.88) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	9.57
Practice expense RVU	8.43
Malpractice RVU	1.88
Total RVU	19.88
Medicare national rate	$664.01
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	$664.01
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 25312 get rejected.

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

Unbundling graft harvest as a separate procedure — harvest is included in 25312 and cannot be billed additionally.
Missing laterality modifier (LT or RT) — most commercial payers and many MACs auto-deny without it.
Medical necessity not established — operative note lacks documented functional deficit or failed conservative or primary repair.
Incorrect units billed — reporting 25312 once for a multi-tendon case without additional units and modifier 51, or vice versa billing excess units without per-tendon documentation.
Global period conflicts — billing routine postoperative visits within the 90-day global without modifier 24 when unrelated to the surgery.

Frequently asked questions

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

01Is graft harvest billed separately when using 25312?

No. Graft harvest is bundled into 25312. Billing a separate graft harvest code alongside 25312 will trigger an NCCI bundling edit and denial.

02How do you bill when two tendons are transferred in the same session?

Report 25312 for the first tendon, then report 25312 again with modifier 51 for each additional tendon. Each unit requires its own tendon named in the operative report.

03What is the global period for 25312 and what does it cover?

25312 carries a 90-day global period. Routine postoperative visits, splint and dressing changes, and therapy referrals written within that window are bundled. An unrelated procedure requires modifier 79; an unplanned return for a related complication requires modifier 78.

04When is modifier 22 appropriate for 25312?

Use modifier 22 when operative complexity is substantially beyond typical — for example, severe adhesions from prior surgery, failed prior transfer, or significant neurovascular involvement requiring additional dissection. The operative note must document the specific factors driving increased work; a generic complexity statement won't hold up on audit.

05Does 25312 require laterality modifiers?

Yes for unilateral procedures — append LT or RT. For bilateral cases in the same session, bill one line with modifier 50. Most commercial payers and Medicare Administrative Contractors require laterality or will deny the claim.

06How does 25312 differ from 25310?

25310 covers tendon transfer or transplantation without a graft — the tendon is simply rerouted. 25312 is used when a graft is required to bridge a defect or augment the transfer, and that graft harvest is included in the 25312 work value. Using 25310 when a graft was harvested will underprice the service and may be flagged in a payer audit.

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, transfer direction (donor to recipient site), graft source and harvest technique, and the number of tendons addressed from dictation. It flags when the operative note omits explicit tendon identification or graft harvest documentation — the two gaps most likely to trigger a medical necessity denial or an NCCI bundling edit on re-audit.

See how Mira captures CPT 25312 documentation