Summary & Overview
CPT 25110: Excision of Lesion from Tendon Sheath, Forearm or Wrist
CPT code 25110 denotes the surgical excision of a lesion from a tendon sheath in the forearm or wrist. This code captures a focused, minor upper-extremity operative procedure that is commonly performed in outpatient surgical settings. It is clinically relevant for musculoskeletal and hand surgery practices and for payers that manage ambulatory surgical benefits.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of code intent and clinical context, payer coverage considerations, and typical sites of service. The publication outlines common billing modifiers and administrative elements where available and highlights benchmarks and policy considerations that affect reimbursement and prior authorization practices nationally.
This summary provides the clinical framing necessary for coding, billing, and utilization review teams to understand when CPT code 25110 applies, how it relates to outpatient surgical workflows, and what operational areas—such as claims adjudication and surgical scheduling—are most affected. Data not available in the input are noted where applicable elsewhere in the full publication.
Billing Code Overview
CPT code 25110 describes a surgical procedure in which a provider excises a lesion from a tendon sheath in the forearm or wrist area. This is a minor operative procedure on the upper extremity involving soft-tissue removal from the tendon sheath.
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Service type: Surgical excision of lesion from tendon sheath (minor upper-extremity surgery)
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Typical site of service: Ambulatory surgery center or outpatient surgical suite; may also be performed in hospital outpatient departments depending on clinical context and facility capabilities.
Clinical & Coding Specifications
Clinical Context
A 45-year-old right-hand-dominant patient presents to an outpatient orthopedic surgery clinic with a painful, palpable nodular lesion localized over the volar wrist and distal forearm along a flexor tendon sheath. Conservative measures including activity modification, splinting, and a corticosteroid injection provided temporary or no relief. Physical exam demonstrates focal tenderness, crepitus with tendon motion, and a discrete mobile mass consistent with a tendon sheath lesion (e.g., ganglion or tenosynovial proliferation). Imaging with ultrasound confirms a well-circumscribed, fluid-filled or solid lesion adjacent to a tendon sheath without neurovascular invasion. The surgeon schedules an operative excision under regional block or local anesthesia with monitored sedation in an ambulatory surgical center.
The clinical workflow includes preoperative evaluation and informed consent, marking the operative extremity (right or left), administration of regional or local anesthesia, a sterile field preparation over the wrist/forearm, careful dissection to expose and excise the lesion from the tendon sheath while protecting surrounding tendons and neurovascular structures, hemostasis, layered closure, dressing application, and postoperative instructions for wound care and hand therapy as indicated. Specimen is sent to pathology when clinically appropriate. Follow-up is arranged for wound check and range-of-motion assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
RT | Right side |