CPT 25120 Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

CPT 25120: Open Excision of Benign Lesion, Distal Radius/Ulna

CPT code 25120 represents an open surgical excision of a benign lesion from the distal radius or ulna (excluding the radial head/neck and the olecranon). This code is used for operative management of benign osseous growths in the forearm and is relevant for surgeons, hospital billing staff, and payers because it defines the procedural work, site of service expectations, and coding specificity necessary for claims processing and coverage determinations nationwide. Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find a concise clinical context explaining when 25120 applies, benchmark information on typical sites of service and common payer considerations, and discussion of billing nuances that affect claim adjudication. The material covers the clinical scenario for coding (open excision of benign bone lesions of the distal radius or ulna), expected facility settings (ambulatory surgery centers and hospital ORs), and common procedural relationships that affect coding choices. Data not available in the input is noted where applicable. This summary is intended to orient clinicians, coders, and policy analysts to the primary purpose and administrative implications of CPT code 25120 on a national level.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 25120upper extremity surgeryorthopedic surgerybenign bone lesionoperative codingambulatory surgeryhospital outpatientprocedure coding

Billing Code Overview

CPT code 25120 describes an open surgical procedure in which the provider makes an incision to expose a portion of the radius or ulna distal to the elbow and removes a benign abnormal growth from any area except the head and neck of the radius and the olecranon process of the ulna.

Service type: Surgical excision of benign lesion of forearm bones (radius or ulna), open approach
Typical site of service: Ambulatory surgery center or hospital operating room for upper extremity orthopedic procedures

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A patient in their mid-40s presents to orthopedic surgery with a palpable, well-circumscribed, benign-appearing osseous mass on the distal radius identified on plain radiographs and confirmed by CT. The patient reports progressive localized pain with forearm rotation and occasional catching but no neurologic deficit. Preoperative evaluation includes history and physical, informed consent, and surgical planning with imaging review to define the lesion location distal to the elbow but not involving the radial head or olecranon process. On the day of surgery the patient undergoes regional block or general anesthesia in an ambulatory surgery center or hospital outpatient department. The surgeon makes a focused incision, dissects to expose the distal radius, performs careful soft-tissue retraction, and excises the benign osseous lesion with curettage or en bloc resection as indicated. Hemostasis is achieved, the site is irrigated, and soft tissues are closed in layers. Specimens are sent for pathology. Postoperative workflow includes immediate recovery, discharge instructions for wound care and activity restrictions, scheduling of pathology follow-up, and outpatient follow-up for wound check and rehabilitation if needed.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the surgeon's professional service separate from technical facility charges when applicable.

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

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

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

CPT-25116-WRIST-EXTENSOR-TENDON-EXCISION-OPEN

CPT 25116: Open Excision Around Extensor Tendons

CPT-25130-WRIST-CARPAL-BONE-EXCISION-BENIGN-LESION

CPT 25130: Excision of Benign Lesion, Exposure of Carpal Bones

CPT-25110-TENDON-SHEATH-LESION-EXCISION-FOREARM-WRIST

CPT 25110: Excision of Lesion from Tendon Sheath, Forearm or Wrist

CPT-25210-CARPAL-BONE-EXCISION-PARTIAL-CARPECTOMY

CPT 25210: Excision of Single Carpal Bone (Partial Carpectomy)

CPT-25112-WRIST-GANGLION-EXCISION-RECURRENT

CPT 25112: Excision of Recurrent Wrist Ganglion

CPT-25136-CARPAL-BONE-EXCISION-WITH-ALLOGRAFT-RECONSTRUCTION

CPT 25136: Carpal Bone Excision with Allograft Reconstruction

CPT-25119-EXTENSOR-TENDON-SHEATH-SYNOVECTOMY-DISTAL-ULNA-EXCISION

CPT 25119: Extensor Tendon Sheath Synovectomy with Distal Ulna Excision

CPT-25115-EXTENSIVE-SOFT-TISSUE-DEBRIDEMENT-BURSA-SYNOVIUM-TENDON

CPT 25115: Extensive Soft Tissue Debridement Involving Bursa/Synovium/Tendon

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Taxonomy Code	Specialty	Notes
207P00000X	Orthopedic Surgery	Primary specialty performing osseous lesion excision of the radius/ulna.
2080P0002X	Hand Surgery	Specialists frequently perform distal forearm bony excisions, especially near wrist and distal radius.
207K00000X	General Surgery	Some general surgeons with orthopedics interest may perform extremity procedures in select settings.
207L00000X	Plastic and Reconstructive Surgery	May be involved when soft-tissue reconstruction or flap coverage is required after excision.
208100000X	Physical Medicine & Rehabilitation	Involved in postoperative rehabilitation planning and nonoperative management prior to surgery.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M85.8`	Other specified disorders of bone	Covers benign localized bone lesions not categorized elsewhere; applicable when documenting osseous growths of the distal radius.
`M85.9`	Disorder of bone, unspecified	Used when a specific bone disorder diagnosis is not yet fully characterized preoperatively.
`M84.50`	Stress fracture, unspecified site, unspecified part of lower limb	Data not applicable to upper extremity; included here only if stress-type lesion of bone considered — otherwise not typically used.
`D16.4`	Benign neoplasm of bone and articular cartilage of upper limb	Directly relevant for benign bone tumors of the radius or ulna.
`S52.5`	Fracture of lower end of radius	Relevant when a prior fracture with symptomatic nonunion or bony prominence requires removal/excision of bone lesion.
`T85.890`	Other complications of internal orthopedic prosthetic devices, implants and grafts	Relevant if prior hardware is present requiring removal during lesion excision.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`24300`	Excision of bone cyst or benign tumor, humerus; proximal or shaft, single or multiple	Similar extremity bone tumor excision code used for lesions of the humerus; provides context for coding larger upper-extremity osseous excisions.
`25075`	Incision and drainage or excision of ganglion, forearm, deep or recurrent	Performed when a soft-tissue ganglion adjacent to distal radius is excised or when differential procedures involve wrist/forearm soft tissue.
`25447`	Excision, lesion of bone, forearm or wrist, excision of benign lesion; radius or ulna	Related code set for forearm/wrist benign bone lesion excision; used when coding differences in anatomic site or extent.
`20610`	Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa)	May be performed preoperatively for diagnostic aspiration of adjacent bursae or postoperatively for symptomatic management.
`20680`	Removal of implant; deep (e.g., buried wires, pins, rods), requiring incision	Applicable when prior hardware in the distal radius or ulna must be removed to access or excise the lesion.
`11012`	Application of skin substitute, local, small area; excision and superficial management	Performed when additional wound management or grafting is required after lesion excision.

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