Summary & Overview
CPT 25125: Excision of Benign Bone Lesion of Radius/Ulna with Autograft Repair
CPT code 25125 covers operative removal of a benign bone lesion from a large area of the forearm (radius or ulna) with repair of the resulting defect using the patient’s own graft tissue. This procedure is clinically significant because it addresses symptomatic cysts or tumors that threaten bone integrity, function, or carry risk of fracture. Nationally, management of benign bone lesions in the forearm involves multidisciplinary coordination among orthopedic surgeons, surgical centers, and payers to balance clinical benefit, site-of-service considerations, and appropriate utilization of grafting techniques.
Key payers in the scope of typical reimbursement and coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise summary of what CPT code 25125 represents, the clinical context for its use, and the common settings for delivery of care. The publication outlines benchmarking topics and policy-relevant considerations such as site-of-service implications and typical surgical service lines, and it highlights areas where payers commonly apply medical necessity and documentation expectations. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 25125 describes surgical excision of an abnormal benign growth (such as a cyst or benign tumor) involving a large area of the radius or ulna in the forearm, with repair of the resultant bony defect using an autograft harvested from another site on the patient.
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Service type: Surgical procedure — open excision of benign bone lesion with autogenous grafting.
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Typical site of service: Hospital operating room or ambulatory surgical center; may occur in specialty orthopedic or hand surgery settings depending on clinical complexity.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45–60-year-old adult presenting with a painful, expansile benign bone lesion (e.g., unicameral bone cyst, aneurysmal bone cyst, benign tumor) of the mid-forearm involving the radius or ulna that has caused cortical thinning, local pain, and risk of pathologic fracture. After clinical evaluation including history, physical exam, radiographs, and usually MRI or CT to define lesion extent, the orthopedic surgeon schedules operative excision. In the operating room under regional or general anesthesia, the surgeon performs an open excision of the cyst or benign tumor, debrides the defect in the diaphyseal or metaphyseal cortex of the radius or ulna, and reconstructs the defect with an autologous bone graft (often harvested from the iliac crest or local corticocancellous source). Intraoperative fluoroscopy confirms complete removal and graft placement. Postoperative workflow includes routine surgical dressing, immobilization (splint or cast), pain control, wound checks, and radiographic follow-up to assess graft incorporation. Typical sites of service are the hospital inpatient or outpatient operating room, ambulatory surgical center, or an outpatient procedure suite when appropriate. Common clinical team members include the orthopedic surgeon (hand/upper extremity or trauma specialist), anesthesiologist, circulating nurse, scrub tech, and physical therapy for postoperative mobilization as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when the procedure is performed on the left forearm (radius/ulna). |