Surgical revision of hand tendons affected by palsy, performed at the wrist or forearm level to restore or improve function compromised by neurological deficit.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $850.72
- Total RVUs
- 25.47
- Global, days
- 90
- Region
- Hand
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 5 cited references ↓
- Named palsy diagnosis with ICD-10 code (e.g., spastic hemiplegia, peripheral nerve palsy) linking medical necessity to the procedure
- Operative note identifying each tendon revised by name, not generic references like 'flexor tendons' or 'standard approach'
- Description of the specific technique performed — lengthening, rerouting, Z-plasty, or other revision method — for each tendon addressed
- Prior treatment history documenting why revision, not primary repair or initial transfer, was indicated
- Laterality documented explicitly (right vs. left hand) to support LT or RT modifier and prevent same-side bilateral billing errors
- Preoperative functional deficit assessment and postoperative plan, particularly if modifier 22 is considered for increased complexity
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 5 cited references ↓
CPT 25316 covers operative revision of hand tendons in the setting of palsy — typically spastic or flaccid paralysis from conditions such as cerebral palsy, stroke sequelae, or peripheral nerve injury. The procedure involves repositioning, lengthening, or otherwise modifying tendons to improve hand posture and function. It is distinct from primary tendon repair and from simple tendon transfer; the revision nature implies prior surgery or progressive deformity requiring correction.
This is a major upper extremity reconstructive procedure with a 90-day global period. All routine follow-up care, dressing changes, and stitch removals through postoperative day 90 are bundled. Separate E/M services billed during the global window require modifier 24 (unrelated evaluation) or modifier 25 (same-day significant separate evaluation). Staged or planned secondary procedures during the global require modifier 58.
Site of service matters here. The HOPD rate significantly exceeds the ASC rate; confirm your facility's contract status before quoting patients out-of-pocket estimates. Because this procedure is uncommon and high-value, payers frequently request operative reports on prepayment or post-payment review. Documentation must be unambiguous about the palsy diagnosis, prior treatment history, and specific tendons revised.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 12.58 |
| Practice expense RVU | 10.21 |
| Malpractice RVU | 2.68 |
| Total RVU | 25.47 |
| Medicare national rate | $850.72 |
| 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 | $850.72 |
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 25316 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing or vague palsy diagnosis — payers deny when the ICD-10 code does not clearly establish neurological basis for tendon dysfunction
- Operative note lacks tendon-level specificity; audit teams flag notes that describe 'wrist tendon revision' without naming structures
- Global period violations — E/M or minor procedure billed within 90 days post-surgery without appropriate modifier 24, 25, or 58
- Bilateral billing errors — both hands billed without modifier 50 or LT/RT pair, or billed as bilateral when only one hand was treated
- Medical necessity not supported when conservative measures (splinting, therapy, chemodenervation) are not documented or discussed in the record
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01What distinguishes 25316 from a standard tendon transfer code?
02Can 25316 be billed bilaterally?
03How do you handle a same-day E/M with 25316?
04What modifier applies if the patient returns to the OR during the 90-day global for a related complication?
05Does modifier 22 hold up for 25316, and what documentation is required?
06Is 25316 typically performed in an ASC or hospital outpatient setting, and does it affect reimbursement?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02mdclarity.comhttps://www.mdclarity.com/cpt-code/25316
- 03novitas-solutions.comhttps://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00085606
- 04cms.govhttps://www.cms.gov/medicare/coding/ncci-coding-edits
- 05aaos.orghttps://www.aaos.org/education/about-aaos-products/coding-resources/
Mira AI Scribe
Mira's AI scribe captures the palsy diagnosis by name, each tendon revised with the specific technique used (lengthening, rerouting, Z-plasty), and explicit laterality from the surgeon's dictation. That prevents the two most common denial triggers for 25316: a vague operative note that fails to name individual tendons and a missing or mismatched neurological diagnosis that leaves medical necessity unsupported on audit.
See how Mira captures CPT 25316 documentation