Summary & Overview
CPT 25135: Excision of Carpal Bone Lesion with Autograft Repair
CPT code 25135 denotes surgical excision of a benign cyst or tumor from the carpal bones with reconstruction of the defect using an autograft. This procedure is relevant across orthopedic and hand surgery practice settings and affects facility and professional billing for operations addressing benign osseous lesions of the wrist. Nationally, accurate coding of such procedures matters for appropriate payment, quality tracking, and procedure-specific utilization monitoring.
Key payers commonly implicated in coverage and reimbursement for this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers of this analysis will find an overview of clinical context for the procedure, typical sites of service and service line placement, common modifiers used with surgical CPT codes, and benchmarks where available. The publication also summarizes coding considerations, potential documentation elements that support medical necessity for excision and grafting, and how this code fits within surgical hand and orthopedic workflows.
Intended for coding professionals, billing managers, and clinical leaders, the summary provides practical context for applying CPT code 25135 in claims and administrative workflows, as well as a concise reference to the procedure’s clinical scope and typical settings.
Billing Code Overview
CPT code 25135 describes surgical excision of a benign lesion from the carpal bones of the wrist with reconstruction of the resulting defect using an autograft taken from another site on the patient. The procedure involves exposure of the carpal bones, removal of a cyst or benign tumor, and repair of the defect created by excision.
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Service type: Surgical excision with autograft reconstruction of carpal bone lesion
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Typical site of service: Outpatient ambulatory surgery center or hospital operating room, depending on clinical complexity and patient factors
Clinical & Coding Specifications
Clinical Context
A 45-year-old right-hand–dominant patient presents to an orthopedic hand surgeon with a gradually enlarging, palpable dorsal wrist mass associated with intermittent wrist pain and occasional limitation of wrist extension. Imaging with wrist radiographs and MRI demonstrates a benign-appearing ganglion or synovial cyst arising from the radiocarpal joint and involving carpal bone contours without malignant features. Conservatively managed options (observation, aspiration) were attempted or considered inappropriate, and the patient elects surgical excision.
Preoperative workflow includes history and physical, informed consent describing excision and possible bone grafting, preoperative localization and marking, and scheduling in an outpatient ambulatory surgery center. Under regional block with monitored anesthesia care or general anesthesia, the surgeon exposes the carpal bones, performs complete excision of the cyst/tumor, evaluates the resulting defect, and harvests an autograft if needed to repair the bony defect. The procedure concludes with layered closure and immobilization; postoperative care includes wound checks, hand therapy referral as indicated, and documentation of graft source and intraoperative findings for coding and billing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral procedure | When identical procedures are performed on both wrists during the same operative session |