CPT 25170 Forearm Tumor Excision Reimbursement | OpenPayer

Summary & Overview

CPT 25170: Excision of Tumor of Radius or Ulna

CPT code 25170 denotes the surgical excision of a tumor of the radius or ulna, including removal of surrounding healthy tissue to achieve complete resection. This orthopedic oncologic procedure is clinically significant because it addresses primary bone tumors or focal metastatic lesions that threaten limb integrity, function, and oncologic control. Nationally, coding and payment for such procedures affect hospital surgical oncology workflows, resource allocation for specialized operating room teams, and post-operative care planning.

Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the code, typical sites of service, and common payer coverage considerations. The publication also outlines relevant benchmarks and policy developments that influence prior authorization, coverage determinations, and outpatient versus inpatient site-of-service decisions. Clinical implications, coding boundaries, and elements that commonly affect utilization and payment decisions are summarized to help billing, clinical, and administrative staff understand how CPT code 25170 is applied in practice.

Data not available in the input is noted where payer-specific rates, related codes, and diagnosis pairings would normally appear.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 25170orthopedic oncologybone tumor excisionforearm surgerysurgical procedureoperating roomambulatory surgical centercoding and billingprocedure code

Billing Code Overview

CPT code 25170 describes the surgical excision of a tumor of the radius or ulna (bones of the forearm), including removal of a margin of surrounding healthy tissue to achieve complete resection of involved bony or soft tissues. The procedure involves removing the lesion from the shaft of the radius or ulna and may require reconstruction or fixation depending on defect size and stability needs.

Service type: Surgical excision of bone tumor (orthopedic oncologic surgery)
Typical site of service: Hospital operating room or ambulatory surgical center with perioperative orthopedic and surgical oncology capabilities

Clinical & Coding Specifications

Clinical Context

A 48-year-old patient presents with a progressively enlarging, painful, palpable mass localized to the distal radius following months of intermittent aching and decreased wrist motion. Imaging (plain radiographs and MRI) demonstrates a solitary lytic lesion centered within the radial diaphysis with cortical thinning and suspicious soft-tissue extension. Orthopedic oncology consultation determines the lesion is most consistent with a primary benign aggressive or low-grade malignant bone tumor (for example, an enchondroma with atypical features or low-grade chondrosarcoma) requiring surgical excision with a margin of normal bone and soft tissue to achieve local control.

Preoperative workflow includes history and physical, informed consent, preop imaging review, and anesthesia evaluation. In the operating room under general anesthesia or regional block with tourniquet control, the orthopedic surgeon performs a limb-sparing en bloc resection of the tumor involving the radius (or ulna) with removal of a margin of adjacent healthy bone and soft tissue. Specimens are marked and sent for frozen section or permanent pathology. Reconstruction may follow immediately (internal fixation, bone graft, allograft, or prosthesis) depending on defect size. Postoperative workflow includes recovery, pain control, immobilization, wound care, pathology review, and follow-up for rehabilitation and adjuvant therapy planning if malignant features are confirmed.

Coding Specifications

Modifier	Description	When to Use
`50`	Bilateral procedure

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

CPT-25112-WRIST-GANGLION-EXCISION-RECURRENT

CPT 25112: Excision of Recurrent Wrist Ganglion

CPT-25101-WRIST-JOINT-EXPLORATION-BIOPSY-FOREIGN-BODY-REMOVAL

CPT 25101: Exploration of Wrist Joint, Possible Biopsy or Foreign Body Removal

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

CPT 25077: Radical Resection of Soft-Tissue Tumor, Forearm/Wrist, <3 cm

CPT-25215-PROXIMAL-ROW-CARPIECTOMY-WRIST-SURGERY

CPT 25215: Proximal Row Carpectomy (Wrist Surgery)

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

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

CPT-25105-WRIST-SYNOVECTOMY-SURGICAL-SYNOVIAL-EXCISION

CPT 25105: Wrist Synovectomy, Surgical Excision of Synovium

CPT-25120-FOREARM-RADIUS-ULNA-BENIGN-LESION-EXCISION-OPEN

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

25111-EXCISION-OF-GANGLION-WRIST-DORSAL-OR

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

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

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

Showing 1–10 of 34

Taxonomy Code	Specialty	Notes
`207X00000X`	Orthopaedic Surgery	Primary specialty performing bone tumor resections of radius/ulna
`2080P0002X`	Orthopedic Oncology	Subspecialty focusing on musculoskeletal tumors and limb-sparing resections
`364S00000X`	General Surgery	May be involved for soft-tissue or combined resections depending on tumor extent
`2086S0125X`	Hand Surgery	Performs distal radius/ulna resections and reconstructions focused on function
`207K00000X`	Plastic and Reconstructive Surgery	Participates when complex soft-tissue coverage or microvascular reconstruction is required

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M85.50`	Other osteopathy, unspecified site	May describe non-specific bone pathology prompting biopsy/excision when exact neoplasm code is not yet established
`M85.59`	Other osteopathy, other site	Used for other specified bone disorders requiring surgical management in upper extremity bones
`M84.361`	Pathological fracture, right radius	Pathologic fracture through a tumor in the radius that may necessitate excision and reconstruction
`M84.362`	Pathological fracture, left radius	Same as above for left-sided lesions
`C40.2`	Malignant neoplasm of long bones of lower limb, pelvis and associated joints — (analogous code family for long bones; upper extremity malignant codes such as `C40.0`/`C41.1` used depending on exact site)	Malignant bone tumors require en bloc excision with margins; site-specific malignant codes are used based on anatomic location
`C41.2`	Malignant neoplasm of short bones of upper limb, scapula and associated joints	Applicable when a primary malignant bone tumor involves the radius or ulna
`D16.1`	Benign neoplasm of radius and ulna	Primary benign bone tumors (e.g., enchondroma, osteochondroma) that are indications for excision when symptomatic or atypical

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11010`	Debridement of extensive eczematous or infected skin (includes removal of foreign material)	May be performed for wound debridement if tumor resection involves significant contaminated or infected soft tissue
`20680`	Removal of implant; deep (e.g., buried wire, pin, screw, metal band, nail, rod or plate)	May be performed later if prior fixation hardware is removed during tumor resection or staged reconstruction
`27130`	Resection arthroplasty, hip (eg, Girdlestone procedure)	Example of a major resection code; included as analogous resection procedure type (not applied to upper extremity) to illustrate reconstruction planning
`20930`	Allograft, morselized or structural, for spine or other sites; includes obtaining graft	Used when structural bone graft or allograft is required to reconstruct a segmental defect after en bloc excision
`24920`	Excision of tumor or tumor-like lesion, radius and/or ulna; partial ostectomy, with or without repair or reconstruction	Commonly paired or considered in the same family of procedures for specific lesion sizes and locations (some coding guidance differentiates extent and technique)

OpenPayer