Summary & Overview
CPT 25126: Forearm Bone Lesion Excision with Bone Graft Reconstruction
CPT code 25126 designates surgical removal of a benign cyst or tumor from a large segment of the radius or ulna with repair of the resulting bone defect using a human bone graft. This operative code is relevant for orthopedic and hand surgeons, hospital billing departments, and payers because it captures a combined resection–reconstruction procedure that typically requires operative time, graft procurement, and postoperative care. Nationally, proper coding affects procedure categorization, facility billing, and episode-of-care accounting for forearm tumor or cyst management. Key payers discussed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical context for when this code is used, benchmarks and utilization perspectives where available, common modifier associations, and payer coverage considerations. The publication explains typical sites of service, the nature of the graft-based reconstruction, and how the code fits into musculoskeletal surgical service lines. Data not available in the input is noted where applicable; the report focuses on code definition, clinical application, and payer coverage scope at a national level.
Billing Code Overview
CPT code 25126 describes surgical excision of a benign lesion or cyst affecting a large area of the radius or ulna of the arm with repair of the resulting osseous defect using a human (autologous or allogeneic) bone graft. This procedure is a musculoskeletal surgical service addressing tumor or cyst removal from the forearm bones and reconstruction of the bone defect created by the excision.
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Service type: Surgical excision with bone graft reconstruction
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45-year-old who presents with progressive forearm pain, swelling, and a palpable mass over the radius/ulna after months of intermittent symptoms. Imaging (radiographs and MRI) demonstrates a benign-appearing bone lesion consistent with an enchondroma or unicameral bone cyst involving a large segment of the radius. The patient is scheduled for operative excision of the tumor/cyst with curettage and reconstruction of the resulting bony defect using a fresh or stored human bone allograft harvested from a tissue bank. The procedure is most often performed in an ambulatory surgery center or hospital operating room under regional or general anesthesia. Intraoperative steps include exposure of the affected bone, en bloc or intralesional excision of the lesion, thorough curettage, assessment of structural integrity, preparation and placement of the allograft to fill the defect, and fixation as needed (internal fixation with plates/screws or supplemental grafting). Postoperative workflow includes radiographic confirmation of graft position, pain control, immobilization (splint or cast) and outpatient orthopedic follow-up with serial radiographs to assess incorporation. Typical payors for billing include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA plans, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or intensity substantially exceeds usual for 25126 due to extensive dissection or complex reconstruction with allograft shaping and fixation |