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CPT code 25109: Tendon excision, each flexor or extensor tendon2026 Medicare rate & RVUs

Reports removal of a flexor or extensor tendon in the forearm or wrist, with each excised tendon counted separately.

CMS RVU26DEffective Oct 1, 2026109 payment localities313 Medicare services in 2024

Medicare pays $506.02 for 25109 nationally in a facility.

Medicare rate · 25109

Tendon excision, each flexor or extensor tendon

Office or facility?

Work RVUs
6.77
Total RVUs
15.15
Global days
090

National rate · 2026

$506.02

Facility setting, before claim adjustments.

See every locality for 25109 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 25109 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 25109 covers

This service removes a flexor or extensor tendon in the forearm or wrist. An orthopedic or hand surgeon may perform it when a tendon itself is diseased or damaged and must be excised. The operative report should identify the tendon, its location, and the extent of removal; a procedure directed at a tendon sheath or a wrist mass is a different service.

Report one unit for each tendon excised, supported by the operative details. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. For bilateral reporting with modifier 50, CMS pays this procedure at 150%. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 25109 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

25109 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$457.72
AlaskaUnavailable$615.13
ArizonaUnavailable$492.48
ArkansasUnavailable$451.74
Atlanta, GAUnavailable$519.15
Austin, TXUnavailable$515.30
Bakersfield, CAUnavailable$516.21
Baltimore area, MDUnavailable$537.14
Beaumont, TXUnavailable$481.65
Brazoria, TXUnavailable$496.22

25109 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
25109 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 25109 rate is calculated

Each of 25109’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 25109

RVUs × geographic indexes × conversion factor

Office or facility?

Work6.77

6.77 RVUs× 1.000 GPCI

Practice expense7.09

7.09 RVUs× 1.000 GPCI

Malpractice1.29

1.29 RVUs× 1.000 GPCI

Adjusted RVUs

15.1500

Conversion factor

$33.4009

Medicare rate

$506.02

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 25109

25109 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 25109

Tendon excision, each flexor or extensor tendon

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 25109

Tendon excision, each flexor or extensor tendon

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

25109 without 50 · national facility

$506.02

Tendon excision, each flexor or extensor tendon

25109-50 · Bilateral: 150%

$759.03

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

25109 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 25109

    Tendon excision, each flexor or extensor tendon6.77 wRVU

    Not priced

  • 25118

    Tendon sheath excision, wrist tenosynovectomy4.4 wRVU

    Not priced

  • 25111

    Wrist ganglion excision, primary ganglion3.44 wRVU

    Not priced

  • 25112

    Tendon lesion excision, recurrent lesion4.55 wRVU

    Not priced

  • 25115

    Lesion excision, wrist or forearm9.84 wRVU

    Not priced

How to choose

25118Tendon sheath excisionWrist tenosynovectomy
Choose 25109 when the tendon itself is excised. Choose 25118 when the work is directed at the tendon sheath.
25111Wrist ganglion excisionPrimary ganglion
25111 describes primary wrist ganglion excision. A ganglion removal alone is not excision of a forearm or wrist tendon.
25112Tendon lesion excisionRecurrent lesion
25112 is for recurrent wrist ganglion excision; 25109 concerns excision of a flexor or extensor tendon.
25115Lesion excisionWrist or forearm
25115 describes radical removal of bursa or synovium involving a forearm or wrist tendon sheath, rather than excision of the tendon itself.

Codes related to 25109

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 25109
CodeHow it relatesNational office range
Used instead
25118Tendon sheath excision, wrist tenosynovectomyUse when the excised tissue is tendon sheath rather than the tendon itself.No office rate
25111Wrist ganglion excision, primary ganglionDescribes primary excision of a wrist ganglion, not tendon excision.No office rate
25112Tendon lesion excision, recurrent lesionDescribes excision of a recurrent wrist ganglion, not tendon excision.No office rate
25115Lesion excision, wrist or forearmFor radical excision of forearm or wrist bursa or synovium involving a tendon sheath.No office rate

25109 billing questions

How is this different from excision of a tendon sheath?

This code is for excision of the tendon itself. Use 25118 when the operative work removes tendon sheath tissue rather than the tendon.

How many units should be reported?

The descriptor is per tendon. Report each tendon excised, and make the operative note clear about the tendon and its forearm or wrist location.

Does excising a wrist ganglion support this code?

Not by itself. A ganglion excision is distinct from removing a flexor or extensor tendon; codes 25111 and 25112 describe primary and recurrent wrist ganglion excisions, respectively.

What is included in the global period?

The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care.

How is bilateral surgery reported?

For bilateral procedures reported with modifier 50, CMS pays this code at 150%.

Can an assistant or co-surgeon be reported?

Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 25109PPRRVU2026_Oct_nonQPP.csv, line 2,391 (RVU26D)

Open CMS sourceHow we calculate rates

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