CPT code 25109: Tendon excision, each flexor or extensor tendon2026 Medicare rate & RVUs in California
Reports removal of a flexor or extensor tendon in the forearm or wrist, with each excised tendon counted separately.
CMS doesn’t publish an office rate for 25109 in California.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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 in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | Unavailable | $516.21 |
| Chico, CA | Unavailable | $512.61 |
| El Centro, CA | Unavailable | $512.82 |
| Fresno, CA | Unavailable | $512.61 |
| Hanford, CA | Unavailable | $512.61 |
| Los Angeles, CA | Unavailable | $544.15 |
| Madera, CA | Unavailable | $512.61 |
| Marin County, CA | Unavailable | $601.29 |
| Merced, CA | Unavailable | $512.61 |
| Modesto, CA | Unavailable | $512.61 |
| Napa, CA | Unavailable | $574.38 |
| Oxnard, CA | Unavailable | $539.21 |
| Redding, CA | Unavailable | $512.61 |
| Rest of California | Unavailable | $512.61 |
| Riverside, CA | Unavailable | $526.49 |
| Sacramento, CA | Unavailable | $532.77 |
| Salinas, CA | Unavailable | $530.69 |
| San Benito County, CA | Unavailable | $615.58 |
| San Diego, CA | Unavailable | $539.49 |
| San Francisco, CA | Unavailable | $599.82 |
| San Luis Obispo, CA | Unavailable | $522.79 |
| Santa Clara County, CA | Unavailable | $609.59 |
| Santa Cruz, CA | Unavailable | $541.69 |
| Santa Maria, CA | Unavailable | $531.67 |
| Santa Rosa, CA | Unavailable | $546.81 |
| Stockton, CA | Unavailable | $512.61 |
| Vallejo, CA | Unavailable | $572.27 |
| Visalia, CA | Unavailable | $512.61 |
| Yuba City, CA | Unavailable | $512.61 |
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
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share 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.
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).
25109 compared with similar codes
Compare codes · National
5 codes, side by side
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.
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
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