Summary & Overview
CPT 25275: Extensor Tendon Repair of Forearm/Wrist with Tissue Graft
CPT code 25275 represents surgical repair of an extensor tendon in the forearm or wrist with application of a tissue graft harvested from the patient, used to address a subluxing extensor carpi ulnaris that produces wrist pain. This code captures a reconstructive tendon procedure that combines primary repair and graft augmentation, and it is relevant to orthopedic and hand surgery practices nationwide.
Primary payers in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, where it is typically performed, and which payer policies and reimbursement considerations are commonly encountered for tendon reconstruction with grafting.
The publication covers national benchmarks for utilization and reimbursement patterns, typical site-of-service settings, and policy updates that affect coverage and prior authorization for surgical tendon repairs. Clinical implications for patient selection and post‑operative care pathways are summarized to clarify the circumstances in which CPT code 25275 is usually billed. Data limitations: Data not available in the input where payer-specific fee schedules, associated taxonomies, and ICD-10 pairings are concerned.
Billing Code Overview
CPT code 25275 describes a surgical procedure in which a provider repairs an extensor tendon in the forearm or wrist and applies a tissue graft taken from another site in the patient’s body. The repair is performed specifically to treat a subluxing extensor carpi ulnaris that is causing wrist pain.
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Service type: Surgical tendon repair with autologous tissue grafting
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Typical site of service: Ambulatory surgical center or hospital operating room, with postoperative care in an outpatient clinic or surgical recovery unit
Clinical & Coding Specifications
Clinical Context
A 45-year-old right-hand dominant manual laborer presents with chronic ulnar-sided wrist pain and occasional snapping of the distal ulna during wrist motion. Conservative treatment including activity modification, splinting, nonsteroidal anti-inflammatory medication, corticosteroid injection, and physical therapy failed to relieve symptoms. Physical exam demonstrates tenderness over the dorsal ulnar wrist and subluxation of the extensor carpi ulnaris (ECU) tendon with forearm rotation. Imaging (wrist radiographs and MRI or dynamic ultrasound) confirms ECU tendon subluxation with tendon attenuation but without full-thickness rupture. The surgeon schedules an operative repair of the ECU/extensor tendon with use of an autologous tissue graft to reconstruct the retinacular constraint and stabilize the tendon.
Procedure workflow: Preoperative evaluation and informed consent occur in the outpatient clinic. On the day of surgery the patient undergoes regional block or general anesthesia in an ambulatory surgical center or hospital outpatient department. The surgeon makes a dorsal/ulnar wrist incision, inspects the ECU tendon and subsheath, harvests an autologous graft (commonly a slip of local tendon or palmaris longus if available), reconstructs the subsheath and repairs the extensor tendon with graft augmentation to correct subluxation, achieves hemostasis, closes the wound, and applies a protective splint or cast. Postoperative care includes immobilization, wound checks, and staged hand therapy to restore range of motion and strength while protecting the repair.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT / |