CPT 25109 Tendon Excision Reimbursement | OpenPayer

Summary & Overview

CPT 25109: Tendon Excision, Forearm/Wrist

CPT code 25109 denotes surgical removal of all or part of a tendon in the forearm or wrist. This procedure is used for tendon injuries, degenerative changes, or other tendon pathologies requiring partial or complete excision. Nationally, tendon procedures in the wrist and distal forearm are clinically significant because they affect hand and wrist function, rehabilitation needs, and post-operative resource use.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical intent, typical settings where the service is performed, and which major payers commonly cover such procedures. The publication presents benchmarks for utilization and reimbursement where available, outlines relevant billing considerations, and summarizes clinical context that payers and providers commonly reference when evaluating claims.

This summary is intended to inform revenue cycle teams, clinical leaders, and policy analysts about the role of CPT code 25109 in surgical hand and wrist care, the typical sites of service for the procedure, and the payer landscape relevant to national coverage and billing practices.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 25109tendon excisionhand surgerywrist surgeryambulatory surgeryoperative procedureorthopedicsbilling

Billing Code Overview

CPT code 25109 describes a surgical procedure in which the provider removes all or part of a tendon in the forearm or wrist area. This procedure is a tendon excision performed to address tendon pathology affecting the distal forearm or wrist.

Service type: Surgical procedure
Typical site of service: Ambulatory surgical center or hospital operating room

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 45-year-old construction worker presenting with chronic dorsal wrist pain, tendon thickening, and triggering after a work-related overuse injury. Conservative management including rest, splinting, nonsteroidal anti-inflammatory drugs, and corticosteroid injection failed over 6–12 weeks. Imaging (ultrasound or MRI) demonstrates tendinopathy with partial tearing or hypertrophic synovitis of an extensor or flexor tendon in the distal forearm/wrist. The surgical workflow includes preoperative evaluation, informed consent, anesthesia (regional block or general), a sterile field over the forearm/wrist, incision and dissection to expose the affected tendon, excision of diseased tendon tissue or segmental tenotomy, hemostasis, layered closure, and application of a dressing and splint. Postoperative care includes pain control, wound checks, activity restrictions, hand therapy referral as indicated, and follow-up for suture removal and functional assessment.

Coding Specifications

Modifier	Description	When to Use
`52`	Reduced services	Use when a portion of the procedure is intentionally not completed resulting in reduced service (e.g., limited tendon excision due to intraoperative findings).
`53`	Discontinued procedure

CPT 25076: Excision of Deep Soft Tissue/Muscle Mass of Forearm or Wrist

CPT-25151-RADIUS-BONE-DEBRIDEMENT-EXCISION-INFECTION

CPT 25151: Excision of Infected Radius Bone

CPT-25078-FOREARM-WRIST-SOFT-TISSUE-TUMOR-WIDE-EXCISION

CPT 25078: Excision of Forearm/Wrist Soft Tissue Tumor with Wide Excision

CPT-25118-EXTENSOR-TENDON-SHEATH-SYNOVECTOMY-WRIST-COMPARTMENT

CPT 25118: Extensor Tendon Sheath Synovectomy, Wrist Compartment

CPT-25135-CARPAL-BONE-LESION-EXCISION-WITH-AUTOGRAFT-REPAIR

CPT 25135: Excision of Carpal Bone Lesion with Autograft Repair

CPT-25065-FOREARM-WRIST-SUPERFICIAL-SOFT-TISSUE-EXCISIONAL-BIOPSY

CPT 25065: Excisional Biopsy of Superficial Soft Tissue, Forearm/Wrist

CPT-25150-FOCAL-BONE-EXCISION-SAUCERIZATION

CPT 25150: Focal Bone Excision (Saucerization)

25111-EXCISION-OF-GANGLION-WRIST-DORSAL-OR

CPT 25111: Excision of Wrist Ganglion (Dorsal or Volar)

CPT-25071-FOREARM-WRIST-SOFT-TISSUE-MASS-EXCISION-3CM-OR-GREATER

CPT 25071: Excision of Soft-Tissue Mass, Forearm or Wrist (≥3 cm)

CPT-25126-FOREARM-BONE-LESION-EXCISION-WITH-BONE-GRAFT-RECONSTRUCTION

CPT 25126: Forearm Bone Lesion Excision with Bone Graft Reconstruction

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Taxonomy Code	Specialty	Notes
`2080P0200X`	Orthopedic Surgery	Orthopedic hand and upper extremity surgeons commonly perform tendon excision/tenotomy.
`207X00000X`	General Surgery	General surgeons with hand expertise may perform select forearm/wrist tendon procedures.
`261QU0200X`	Hand Surgery	Fellowship-trained hand surgeons focus on tendon pathologies of the wrist and forearm.
`2086S0102X`	Plastic Surgery	Plastic surgeons performing hand surgery undertake complex tendon reconstructions and excisions.
`207L00000X`	Physical Medicine & Rehabilitation	PM&R physicians may perform injections and coordinate postoperative rehabilitation but do not typically bill operative codes.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M65.321`	Trigger finger, right thumb	Tendon pathology causing triggering that may require partial tendon excision or pulley release when conservative care fails.
`M65.322`	Trigger finger, left thumb	Same as above for the left side.
`M65.30`	Trigger finger, unspecified finger	General trigger digit diagnosis associated with tenolysis or partial tendon excision.
`M65.4`	Radial styloid tenosynovitis (De Quervain)	Tenosynovitis of the first dorsal compartment may require surgical release or excision of diseased tendon tissue.
`M67.831`	Other synovial cyst, right hand	Cystic lesions adjacent to tendons that can cause tendon irritation and may necessitate tendon sheath or tendon surgery.
`M24.20`	Disorder of ligament, unspecified ankle and foot	Data not available in the input.
`S56.011A`	Strain of flexor muscle, right forearm, initial encounter	Acute tendon injury that may require surgical excision of irreparably damaged tendon segments.
`S56.012A`	Strain of flexor muscle, left forearm, initial encounter	Same as above for the left forearm.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`25100`	Excision of flexor tendon sheath or tenolysis, forearm and/or wrist	Performed for release of adhesions or sheath pathology; may be done in conjunction with partial tendon excision.
`25320`	Repair, flexor, forearm and/or wrist; with free tendon graft (includes harvesting)	Relevant when excision results in a defect requiring tendon grafting or reconstruction after diseased segment removal.
`26055`	Tendon repair, hand, primary or secondary; complex multi-tendon or with graft	May be used if the excised tendon segment is repaired or reconstructed as part of the same surgical episode.
`20550`	Injection(s); single tendon sheath, or ligament, trigger digit	Preoperative or diagnostic corticosteroid injection for tendinopathy or trigger phenomena; often part of conservative management.
`20610`	Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., wrist joint aspiration)	Used diagnostically or therapeutically prior to operative management to evaluate inflammatory causes.

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