Flexor tendon origin release at the forearm to correct hand deformity caused by palsy — a reconstructive procedure that repositions muscle-tendon units to restore functional hand posture.

Verified May 8, 2026 · 7 sources ↓

Medicare: $720.79
Total RVUs: 21.58
Global, days: 90
Region: Wrist

Drawn from CMSBedrockbillingAAPCEatonhandEmedny

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify the underlying palsy etiology (e.g., cerebral palsy, Volkmann's ischemic contracture, brachial plexus palsy) with supporting diagnosis codes
Operative note must name the specific tendons and proximal origin sites released — do not use generic terms like 'flexor tendons'
Document the preoperative functional deficit and deformity pattern (e.g., wrist/finger flexion contracture, intrinsic-minus posture) with clinical measurements
Record the surgical approach, extent of mobilization achieved intraoperatively, and any concomitant procedures performed
Include conservative treatment history (splinting, occupational therapy, botulinum toxin) demonstrating medical necessity for surgical intervention
Post-op notes within the 90-day global period must distinguish routine wound/splint care from any unrelated E&M services

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 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 25315 describes a flexor slide procedure in which the origins of the flexor tendons are released from the proximal forearm, allowing the musculotendinous units to migrate distally. The goal is to correct the intrinsic-minus or spastic/paralytic deformity pattern seen in conditions such as cerebral palsy, Volkmann's contracture sequelae, or other upper motor neuron and peripheral nerve palsies affecting hand function. The release reduces the fixed flexion posture of the wrist and fingers without severing the tendons themselves.

This is categorized under Repair, Revision, and/or Reconstruction Procedures on the Forearm and Wrist. It carries a 90-day global period, meaning all routine post-op management — wound checks, dressing changes, splint adjustments, and therapy referral visits by the operating surgeon — are bundled through day 90. Any service unrelated to the palsy hand reconstruction during that window requires modifier 79; a related unplanned return to the OR uses modifier 78.

Site of service matters here. The HOPD and ASC payment rates differ substantially (see the Site of Service comparison table on this page). Because this procedure is rarely performed in an office setting, confirm facility credentialing and prior authorization requirements before scheduling. Documentation must connect the tendon pathology directly to the palsy diagnosis — vague operative notes citing only 'contracture' without naming the underlying neuromuscular etiology are a common audit trigger.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.41
Practice expense RVU	8.96
Malpractice RVU	2.21
Total RVU	21.58
Medicare national rate	$720.79
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	$720.79
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 25315 get rejected.

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

Diagnosis code does not establish a palsy or neuromuscular etiology — payers deny when the linked ICD-10 reflects only contracture (M24.5x) without an underlying palsy
Missing or inadequate prior authorization for the facility site of service, particularly HOPD versus ASC
Bundling of concomitant tendon procedures without modifier 59 or XS to establish distinct operative services on separate structures
Operative note lacks specificity on which tendons were released, triggering medical necessity denial or downcoding
Claim submitted during the 90-day global of a prior forearm or wrist procedure without modifier 79 for unrelated service or 78 for related return to OR

Frequently asked questions

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

01What diagnoses support medical necessity for CPT 25315?

The ICD-10 must reflect a palsy or neuromuscular condition driving the tendon deformity — cerebral palsy (G80.x), sequelae of Volkmann's contracture, brachial plexus injury (S14.x or G54.0), or spastic hemiplegia are common. A standalone contracture code without an underlying palsy etiology will draw a medical necessity denial from most payers.

02Can 25315 be billed bilaterally?

Yes, if the procedure is performed on both hands in the same session, append modifier 50. Document bilateral deformity and functional deficit independently for each extremity. Some payers require LT and RT on separate line items rather than modifier 50 on a single line — check payer-specific instructions before submitting.

03Is modifier 22 ever justified for this procedure?

Yes, when operative complexity is substantially greater than typical — for example, extensive scarring from prior surgery, revision after failed prior release, or a combined palsy pattern requiring wider dissection than standard. The operative note must document the specific factors adding time and complexity, and the surgeon should attach a cover letter quantifying the additional work.

04What is the global period and what does it cover?

CPT 25315 carries a 90-day global period. That includes the day before surgery, the operative day, and all routine post-op visits, splint checks, wound care, and suture removal through day 90. If you bill a separate E&M for a condition unrelated to the palsy hand procedure during that window, append modifier 79 and document the distinct medical issue clearly.

05How do I handle a same-day E&M with 25315 on the operative day?

A decision-for-surgery E&M on the same day as 25315 requires modifier 57 if the decision was made at that visit. Modifier 25 applies if the E&M addresses a separately identifiable problem distinct from the surgical indication. Document the distinct medical decision-making — do not rely on the operative note alone to support the E&M.

06Can 25315 be billed with other forearm tendon procedures on the same day?

Possibly, but NCCI edits bundle many forearm tendon codes together. If separate tendon procedures are genuinely distinct — different tendons, different operative goals — append modifier 59 or XS and document each procedure's individual rationale in the operative note. Review the NCCI PTP edit table for 25315 before submitting any companion forearm procedure codes.

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 palsy etiology, the specific flexor tendon origins released, the extent of distal muscle migration achieved, and the functional deformity being corrected — directly from surgeon dictation. This prevents the two most common denial triggers for 25315: a diagnosis mismatch between the operative note and the submitted ICD-10, and an operative report that names only 'flexor tendons' without identifying individual structures and surgical extent.

See how Mira captures CPT 25315 documentation