Summary & Overview
CPT 25260: Flexor Tendon Repair, Forearm or Wrist
CPT code 25260 covers acute surgical repair of a flexor tendon or muscle in the forearm or wrist performed soon after traumatic injury. This code is clinically important because timely repair of flexor tendons affects functional outcomes and can drive differences in site-of-service, resource use, and authorization patterns nationwide. Courtship between clinical urgency and payer policy influences utilization and reimbursement for these procedures across commercial and public payers.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides national benchmarks for utilization and reimbursement where available, summarizes common policy and coverage considerations, and outlines clinical context that affects coding and billing (timing of repair, operative setting, and procedure complexity). Readers will find a concise overview of coding intent, expected service lines, and typical sites of care, plus guidance on what information is available and what is not (for example, specific ICD-10 pairings and detailed payer-specific rules are not included here). The content is intended for payers, revenue cycle professionals, and clinical leaders seeking a clear national summary of CPT code 25260 and its role in acute hand and forearm trauma care.
Billing Code Overview
CPT code 25260 describes a surgical repair of a flexor tendon or muscle in the forearm or wrist performed promptly after a traumatic injury. This procedure represents an acute operative intervention to restore tendon continuity and hand/forearm function following laceration or severe soft-tissue trauma.
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Service type: Surgical repair of flexor tendon or muscle (acute trauma repair)
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Typical site of service: Ambulatory surgery center or hospital operating room
Clinical & Coding Specifications
Clinical Context
A 28-year-old male presents to the emergency department after a machinery-related laceration to the volar forearm incurred at work. On exam there is a deep transverse laceration 6 cm proximal to the wrist with inability to actively flex the index and middle fingers. Neurovascular status is intact distally. Plain radiographs exclude bony injury. The patient is consented for urgent operative exploration and primary repair of flexor tendons in the forearm/wrist under regional block with monitored anesthesia care.
Perioperative workflow: triage and initial wound care in the ED, hand surgery consultation, preoperative consent and anesthesia evaluation, operative repair of the severed flexor tendon(s) using standard atraumatic technique with early active motion protocol initiation in the post-anesthesia care unit, outpatient hand therapy referral, and scheduled postoperative follow-up visits to monitor healing and range of motion.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the repair required substantially greater work or complexity than usual (document increased work). |
23 | Unusual anesthesia |