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Billing code 25263: Tendon repairMedicare rate & RVUs

Reports primary repair of a single extensor tendon or muscle in the forearm or wrist, such as direct repair after an acute injury.

CMS RVU26DEffective Oct 1, 2026109 payment localities106 Medicare services in 2024

Medicare pays $607.90 for 25263 nationally in a facility.

Medicare rate · 25263

Tendon repair

Swap in your local Medicare rate.

Work RVUs
7.84
Total RVUs
18.20
Global days
090

National rate · 2026

$607.90

Facility setting, before claim adjustments.

See every locality for 25263 → · 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.

On this page 10 sections
  1. Medicare rate
  2. What 25263 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 25263 covers

This code represents primary surgical repair of one extensor tendon or muscle in the forearm or wrist. A hand, orthopedic, or plastic surgeon may use it to restore continuity after an acute injury, such as a laceration with tendon damage, when the tissue can be repaired directly. The work centers on identifying the injured structure and securing its ends; it is not the code for a delayed reconstruction or a repair requiring a graft.

Report the code for each tendon or muscle repaired, with the operative note identifying the structure, injury, repair method, and why the repair is primary. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this code. An assistant at surgery may be 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 25263 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

25263 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$547.41
Alaska*Unavailable$732.65
ArizonaUnavailable$590.87
ArkansasUnavailable$539.92
AtlantaUnavailable$624.54
AustinUnavailable$618.90
BakersfieldUnavailable$618.93
Baltimore/Surr. CntysUnavailable$646.49
BeaumontUnavailable$577.81
BrazoriaUnavailable$595.11

25263 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
25263 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 25263 rate is calculated

Each of 25263’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 · 25263

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 7.84Practice expense 8.69Malpractice 1.67

18.2000 adjusted RVUs×$33.4009 conversion factor=$607.90

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 25263

25263 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 25263

Tendon repair

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)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
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 · 25263

Tendon repair

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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 51 · payment effect

With and without the modifier

25263 without 51 · national facility

$607.90

Tendon repair

25263-51 · Second procedure: 50%

$303.95

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

25263 compared with similar codes

Compare codes

25263 vs 25260 vs 25265 vs 25270 vs 25272: national Medicare rates

Swap in your local Medicare rate.

  • 25263
    Tendon repair · 7.84 wRVU
    —
  • 25260
    Flexor tendon repair · 7.84 wRVU
    —
  • 25265
    Flexor tendon repair · 9.85 wRVU
    —
  • 25270
    Extensor tendon repair · 6.02 wRVU
    —
  • 25272
    Tendon repair · 7.03 wRVU
    —

How to choose

25260Flexor tendon repair
Choose 25260 for primary repair of a flexor tendon or muscle; choose 25263 for a primary extensor repair.
25265Flexor tendon repair
25265 describes secondary repair of a flexor tendon or muscle. It is not the primary extensor repair represented by 25263.
25270Extensor tendon repair
25270 is for secondary repair of an extensor tendon or muscle. Use 25263 for primary repair.
25272Tendon repair
25272 is a secondary extensor repair code involving a free graft; 25263 describes primary repair.

Codes related to 25263

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

Codes related to 25263
CodeHow it relatesNational office range
Same family
25260Flexor tendon repairPrimary repair of a flexor tendon or muscle in the forearm or wrist.No office rate
25265Flexor tendon repairSecondary repair of a flexor tendon or muscle in the forearm or wrist.No office rate
25270Extensor tendon repairSecondary repair of an extensor tendon or muscle in the forearm or wrist.No office rate
25272Tendon repairSecondary extensor tendon or muscle repair involving a free graft.No office rate
25274Tendon repairA related secondary extensor tendon or muscle repair code.No office rate

25263 billing questions

How does this differ from 25260?

25263 is for primary repair of an extensor tendon or muscle. 25260 is the corresponding primary repair code for a flexor tendon or muscle.

When is a secondary repair code more appropriate?

Use a secondary repair code when the surgeon is reconstructing a delayed injury rather than primarily repairing the tendon or muscle. The operative report should support the timing and nature of the repair.

Is the code reported per tendon?

Yes. The code describes a single tendon or muscle, so document each structure repaired and report units according to the applicable coding instructions.

Does the repair include related postoperative visits?

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

Can modifier 50 be used for repairs on both sides?

No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.

May an assistant surgeon be reported?

An assistant at surgery may be paid for this procedure. Co-surgeons and team surgery are not permitted under the CMS rules supplied for this code.

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 25263PPRRVU2026_Oct_nonQPP.csv, line 2,419 (RVU26D)

Open CMS sourceHow we calculate rates

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