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    v1.0.28
    OpenPayerBilling CodesExcision Procedures on the Forearm and WristCPT cpt-25118-extensor-tendon-sheath-synovectomy-wrist-compartment
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    CPT 25118: Extensor Tendon Sheath Synovectomy, Wrist Compartment

    Medicare pays $379 on average nationally for this procedure.

    CPT code 25118 describes a surgical procedure to expose an extensor tendon and excise the synovial layer from the extensor tendon sheath within a limited wrist compartment; service type: surgical excision of tendon sheath synovium; typical site of service: outpatient or ambulatory surgical center or hospital operating room for a localized wrist procedure.

    For related coverage guidance, see recent payer policy updates: Fixed Wing Air Ambulance Transport, Air Ambulance, Ambulance Services (for New Mexico Only).

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 52-year-old right-hand-dominant office worker presents with a several-month history of dorsal radial wrist pain, swelling, and painful wrist extension exacerbated by repetitive thumb and wrist movements. Examination reveals focal tenderness over the first extensor compartment with crepitus and reduced function consistent with stenosing tenosynovitis (De Quervain disease) refractory to conservative care (splinting, NSAIDs, corticosteroid injection). Imaging (ultrasound or radiographs) excludes fracture and shows tenosynovial hypertrophy localized to the extensor tendon sheath. The surgical workflow for 25118 includes preoperative consent and localization of the involved extensor compartment, regional or local anesthesia with monitored sedation, a small longitudinal incision to expose the extensor tendon, excision of the synovial layer from the extensor tendon sheath within the affected compartment, hemostasis, and layered wound closure. Postoperative care includes dressing application, brief immobilization in a splint, discharge with wound care instructions, and outpatient follow-up for suture removal and hand therapy as indicated. Typical site of service is an ambulatory surgery center or hospital outpatient department; the service type is a minor hand/wrist surgical procedure performed by an orthopedic hand surgeon, plastic surgeon with hand specialty, or a hand surgeon credentialed in a general surgery or orthopedic practice.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    20550Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., trigger finger)May be performed preoperatively as a diagnostic or therapeutic corticosteroid injection to the tendon sheath before deciding on 25118.
    26055Tendon sheath incision; for trigger fingerA related finger flexor sheath procedure—similar concept of sheath release but at a different anatomical site; performed when stenosing tenosynovitis is in the digits rather than the wrist.
    25290Excision, lesion of wrist or hand soft tissue (e.g., ganglion)Performed when additional soft-tissue lesions (ganglion cysts) are excised from the wrist during the same operative session as 25118.
    29848Arthroscopy, wrist, surgical; synovectomy, partialUsed when a more extensive synovectomy of the wrist joint via arthroscopy is required in addition to or instead of open compartment synovectomy represented by 25118.
    99024Postoperative follow-up visit global (professional services)Represents outpatient postoperative visits associated with surgical procedures like 25118 and is used in global period billing and follow-up scheduling.

    Related Modifiers

    11 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…

    Showing 1–10 of 11

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207X00000XOrthopaedic Surgery PhysicianAn orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated…
    208000000XPediatrics PhysicianA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
    2086S0105XSurgery of the Hand (Surgery) PhysicianA surgeon with expertise in the investigation, preservation and restoration by medical, surgical and rehabilitative means, of all structures of the up…
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    163WN0300XNephrology Registered NurseNursing Service Providers · Registered Nurse
    305R00000XPreferred Provider OrganizationA group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the phys…
    207NP0225XPediatric Dermatology PhysicianA pediatric dermatologist has, through additional special training, developed expertise in the treatment of specific skin disease categories with emph…
    207RH0002XHospice and Palliative Medicine (Internal Medicine) PhysicianAn internal medicine physician with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illne…

    Related Payer Policy Updates

    Specialty: Emergency & Medical Transportation1 / 3

    10 rows

    PolicyPayerEffective Date
    Fixed Wing Air Ambulance TransportCigna2026-08-15
    Air AmbulanceAmbetter Georgia2026-08-01
    Ambulance Services (for New Mexico Only)UnitedHealthcare2026-08-01
    Ambulance Services (for Tennessee Only)UnitedHealthcare2026-08-01
    Clinical Policy: Air AmbulanceArizona Complete Health2026-08-01
    Air AmbulanceCentene2026-08-01
    Clinical Policy: Air AmbulanceCentene2026-08-01
    Clinical Policy: Air AmbulanceAmbetter Nevada2026-08-01
    Ambulance TransportProvidence Health Plan2026-07-01
    Air ambulance transport coverage criteriaeocco2026-07-01

    Related Codes

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

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

    CPT-25066-FOREARM-WRIST-SUBFASCIAL-INTRAMUSCULAR-BIOPSY

    CPT 25066: Biopsy of Subfascial/Intramuscular Soft Tissue, Forearm/Wrist

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

    CPT 25071: Excision of Forearm/Wrist Soft Tissue Mass, ≥3 cm

    CPT-25073-FOREARM-WRIST-DEEP-SOFT-TISSUE-MASS-EXCISION-3CM-OR-GREATER

    CPT 25073: Excision of Deep Soft Tissue Mass, Forearm or Wrist

    CPT-25075-FOREARM-WRIST-SUBCUTANEOUS-MASS-EXCISION-3CM-OR-LESS

    CPT 25075: Excision of Subcutaneous Mass of Forearm or Wrist, ≤3 cm

    CPT-25076-FOREARM-WRIST-DEEP-SOFT-TISSUE-MASS-EXCISION-3CM-OR-LESS

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

    CPT-25077-RADICAL-RESECTION-SOFT-TISSUE-FOREARM-WRIST-LESS-THAN-3CM

    CPT 25077: Radical Resection of Forearm/Wrist Soft Tissue Tumor

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

    CPT 25078: Excision of Forearm/Wrist Soft Tissue Tumor, Extensive

    CPT-25085-WRIST-JOINT-CAPSULOTOMY-RELEASE-CONTRACTURE

    CPT 25085: Wrist Capsulotomy for Contracture Release

    CPT-25100-WRIST-JOINT-BIOPSY-INCISION

    CPT 25100: Wrist Joint Incision with Biopsy

    Showing 1–10 of 34

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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