CPT code 25118: Tendon sheath excision, wrist tenosynovectomy2026 Medicare rate & RVUs in Illinois
Reports surgical removal of diseased wrist tendon sheath tissue, commonly for persistent tenosynovitis when the operative target is the sheath rather than the tendon or joint.
CMS doesn’t publish an office rate for 25118 in Illinois.
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 25118 covers
A hand or orthopedic surgeon removes abnormal synovial tissue from around wrist tendons, as in a tenosynovectomy for persistent inflammatory or proliferative tenosynovitis. A typical clinical setting is surgery for wrist tendon-sheath disease, including disease associated with rheumatoid arthritis. The operative target is the tendon sheath and its diseased lining, not the tendon itself or the wrist joint lining.
Report the code when the documented procedure excises wrist tendon sheath tissue; a discrete cyst or other focal lesion may instead point to a lesion-excision code. The operative report should identify the wrist, the involved sheath or tendon compartment, the condition treated, and the tissue removed. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery services are not paid; 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 25118 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | Unavailable | $408.08 |
| East St. Louis, IL | Unavailable | $382.62 |
| Rest of Illinois | Unavailable | $368.60 |
| Suburban Chicago, IL | Unavailable | $397.69 |
How the 25118 rate is calculated
Each of 25118’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 · 25118
RVUs × geographic indexes × conversion factor
Work4.40
4.40 RVUs× 1.000 GPCI
Practice expense5.83
5.83 RVUs× 1.000 GPCI
Malpractice0.84
0.84 RVUs× 1.000 GPCI
Adjusted RVUs
11.0700
Conversion factor
$33.4009
Medicare rate
$369.75
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 25118
25118 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 25118
Tendon sheath excision, wrist tenosynovectomy
| 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 · 25118
Tendon sheath excision, wrist tenosynovectomy
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
25118 without 50 · national facility
$369.75
Tendon sheath excision, wrist tenosynovectomy
25118-50 · Bilateral: 150%
$554.63
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).
25118 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 25105Wrist synovectomyOpen approach
- Choose 25118 when the operative target is wrist tendon sheath tissue. Choose 25105 when the surgeon removes the lining of the wrist joint.
- 25109Tendon excisionEach flexor or extensor tendon
- 25118 addresses the sheath surrounding wrist tendons; 25109 is for excision of tendon tissue in the forearm or wrist.
- 25110Lesion excisionTendon sheath or capsule
- 25118 describes excision of diseased wrist tendon sheath tissue, commonly a tenosynovectomy. 25110 is directed to a discrete lesion of the tendon sheath or capsule.
25118 billing questions
When is this code appropriate instead of a tendon lesion excision code?
Use this code for removal of diseased wrist tendon sheath tissue, such as a tenosynovectomy. A discrete cyst or other localized lesion of the sheath may fit a lesion-excision code instead.
How is this different from wrist joint synovectomy?
This procedure removes tissue around wrist tendons. Wrist joint synovectomy addresses the lining inside the joint.
What should the operative note document?
Document the wrist and involved tendon sheath or compartment, the underlying condition, and the sheath tissue excised. The note should make clear that the work involved the sheath rather than the tendon or joint lining.
Does Medicare include related postoperative visits in the payment?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How does Medicare handle bilateral procedures and other procedures in the same session?
Bilateral reporting with modifier 50 is paid at 150%. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and the others at 50%.
Can an assistant or co-surgeon be reported for this operation?
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
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