FeeBase
Log inGet started
Menu

CPT code 25118: Tendon sheath excision2026 Medicare rate & RVUs

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 RVU26DEffective Oct 1, 2026109 payment localities3.3K Medicare services in 2024

Medicare pays $369.75 for 25118 nationally in a facility.

Medicare rate · 25118

Tendon sheath excision

Office or facility?

Work RVUs
4.4
Total RVUs
11.07
Global days
090

National rate · 2026

$369.75

Facility setting, before claim adjustments.

See every locality for 25118 →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 25118 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 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

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

109 of 109 payment localities

25118 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$333.23
AlaskaUnavailable$443.29
ArizonaUnavailable$359.67
ArkansasUnavailable$328.68
Atlanta, GAUnavailable$378.94
Austin, TXUnavailable$378.14
Bakersfield, CAUnavailable$380.26
Baltimore area, MDUnavailable$392.96
Beaumont, TXUnavailable$350.23
Brazoria, TXUnavailable$363.00

25118 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

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
25118 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 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

Office or facility?

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

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 · 25118

Tendon sheath excision

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

25118 without 50 · national facility

$369.75

Tendon sheath excision

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).

When to use modifier 50

25118 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 25118

    Tendon sheath excision4.4 wRVU

    Not priced

  • 25105

    Wrist synovectomy5.87 wRVU

    Not priced

  • 25109

    Tendon excision6.77 wRVU

    Not priced

  • 25110

    Lesion excision3.94 wRVU

    Not priced

How to choose

25105Wrist synovectomy
Choose 25118 when the operative target is wrist tendon sheath tissue. Choose 25105 when the surgeon removes the lining of the wrist joint.
25109Tendon excision
25118 addresses the sheath surrounding wrist tendons; 25109 is for excision of tendon tissue in the forearm or wrist.
25110Lesion excision
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.

Codes related to 25118

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

Codes related to 25118
CodeHow it relatesNational office range
Used instead
25105Wrist synovectomyTreats wrist joint lining rather than the synovial tissue surrounding wrist tendons.No office rate
25109Tendon excisionApplies when the excised structure is tendon tissue, rather than the tendon sheath.No office rate
25110Lesion excisionFor excision of a localized lesion of the tendon sheath or capsule, rather than sheath synovectomy.No office rate

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

Show the CMS file lines behind this rate
RVUs for 25118PPRRVU2026_Oct_nonQPP.csv, line 2,397 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 25118 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 25118 and the rest of your codes on one sheet

Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.

Build my fee sheetOr price your code list free →