CPT 25031 Incision & Drainage Reimbursement | OpenPayer

Summary & Overview

CPT 25031: Incision and Drainage of Forearm or Wrist Bursal Abscess

CPT code 25031 denotes incision and drainage of an abscess in an infected bursa of the forearm or wrist. This minor operative procedure is an important component of musculoskeletal and wound care that addresses localized infections that can cause pain, impaired function, and risk of deeper spread. Nationally, timely drainage of bursal abscesses affects utilization across outpatient surgery settings and emergency care.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find a concise overview of clinical indications and service settings, typical billing considerations tied to this procedure, and what to expect in payer coverage patterns. The publication also summarizes available benchmarks for utilization and reimbursement where present and highlights relevant policy or documentation themes that affect claims adjudication.

The report is designed for clinicians, coding professionals, and policy analysts seeking a national summary of CPT code 25031 — covering clinical context, service delivery sites, and payer scope. Data not available in the input will be noted as such in dedicated sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare25031CPTincision and drainagebursal abscessforearm wristminor surgeryoutpatientambulatory surgerywound care

Billing Code Overview

CPT code 25031 describes the surgical incision and drainage of an abscess in an infected bursa of the forearm or wrist. The procedure involves making an incision to evacuate purulent material from the bursal space to resolve infection and reduce localized inflammation.

Service type: Minor surgical procedure, incision and drainage
Typical site of service: Outpatient clinic or ambulatory surgical center; may also be performed in an emergency department when clinically indicated

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult presenting to an urgent care clinic or emergency department with a painful, fluctuant swelling over the dorsal or volar wrist or distal forearm. The patient reports localized erythema, warmth, and increasing pain over 24–72 hours, with reduced range of motion of the wrist. Vital signs may show low-grade fever. The clinician performs a focused history and physical exam, documents fluctuance consistent with an abscess of a wrist or forearm bursa, and obtains point-of-care ultrasound if available to confirm a fluid collection superficial to tendon sheaths or bursal spaces. Indications for incision and drainage under CPT code 25031 include a localized infected bursa with purulent material requiring surgical drainage. The workflow commonly includes consent, wound culture and Gram stain, local or regional anesthesia (digital block or local infiltration), incision and drainage with exploration and irrigation of the bursa, placement of a wick or small drain if needed, dressing application, and provision of wound care and antibiotic prescriptions. Post-procedure documentation includes size and location of incision, estimated drainage volume, organisms sent for culture, anesthesia type and amount, hemostasis achieved, and follow-up instructions for dressing changes and possible hand surgery follow-up if deeper infection is suspected.

Coding Specifications

Modifier	Description	When to Use
`22`

CPT 25020: Forearm/Wrist Fasciotomy for Compartment Decompression

CPT-25023-FOREARM-WRIST-FASCIOTOMY-DEBRIDEMENT

CPT 25023: Forearm/Wrist Fasciotomy with Debridement

CPT-25001-FLEXOR-TENDON-SHEATH-INCISION-WRIST

CPT 25001: Incision of Flexor Tendon Sheath, Wrist

CPT-25025-FOREARM-WRIST-COMPARTMENT-FASCIOTOMY-DEBRIDEMENT

CPT 25025: Forearm/Wrist Fasciotomy and Debridement

CPT-25040-WRIST-JOINT-EXPLORATION-DRAINAGE-FOREIGN-BODY

CPT 25040: Wrist Joint Exploration, Drainage, or Foreign Body Removal

CPT-25024-FOREARM-WRIST-FASCIOTOMY-COMPARTMENT-RELEASE

CPT 25024: Forearm/Wrist Fasciotomy for Compartment Release

CPT-25028-DEEP-FOREARM-WRIST-INCISION-AND-DRAINAGE

CPT 25028: Incision and Drainage of Deep Abscess or Hematoma, Forearm/Wrist

CPT-25035-FOREARM-WRIST-INCISION-DRAINAGE-INFECTED-BONE

CPT 25035: Incision of Infected Bone, Forearm or Wrist

CPT-25000-EXTENSOR-TENDON-SHEATH-RELEASE-WRIST

CPT 25000: Extensor Tendon Sheath Release, Wrist

Taxonomy Code	Specialty	Notes
207P00000X	Orthopedic Surgery	Orthopedic surgeons commonly manage complex or deep infections of the wrist/forearm.
2080P0004X	General Surgery	General surgeons may perform drainage in emergency settings for accessible superficial bursae.
207L00000X	Hand Surgery	Hand surgeons perform targeted drainage with attention to tendon and neurovascular structures.
261G00000X	Emergency Medicine	Emergency physicians frequently perform bedside incision and drainage for superficial infected bursae.
207K00000X	Plastic Surgery	Plastic surgeons may be involved for complex soft-tissue infections or reconstructive needs.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`L02.419`	Cutaneous abscess of unspecified part of limb	Represents localized skin/soft tissue abscess that may involve or be adjacent to a bursa requiring I&D.
`M70.01`	Olecranon bursitis, right elbow	Bursal infection of a superficial joint-area; similar pathology when a wrist or forearm bursa is infected.
`M71.2`	Other bursitis, forearm	Directly relevant to infected bursae in the forearm that may require drainage.
`M65.861`	Abscess of tendon sheath, right forearm	Tendon sheath abscess can be adjacent to bursal infections and may necessitate incision and drainage.
`L03.115`	Cellulitis of right upper limb	Cellulitis often coexists with bursal abscess and helps justify antibiotic therapy and procedural intervention.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`12031`	Repair, intermediate, face, ears, eyelids, nose, or mouth; 2.6 cm to 7.5 cm	May be used if laceration repair is required in addition to drainage when overlying skin is incised and repaired.
`10180`	Incision and drainage, complex, postoperative wound infection; deep abscess, complicated or extensive drainage	May be performed when infection involves deeper soft tissues beyond a superficial bursal space and requires more extensive debridement.
`99024`	Postoperative follow-up visit, unrelated to E/M with global period	Use for subsequent related postoperative visits during the global period as defined by payors.
`99212`	Office or other outpatient visit for the evaluation and management of an established patient, straightforward medical decision making	Commonly billed for pre- or post-procedure evaluation in clinic or urgent care when an E/M visit is separately reported.
`20610`	Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee); without ultrasound guidance	May be used for diagnostic aspiration of a bursal fluid when surgical drainage is not performed.

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