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Billing code 25035: Bone incisionMedicare rate & RVUs in Austin

Opening the cortex of a forearm or wrist bone provides surgical access to infected bone, such as in osteomyelitis or a bone abscess.

CMS RVU26DEffective Oct 1, 2026One payment locality105 Medicare services in 2024

In Austin, Medicare pays $573.07 for 25035 in a facility. There’s no office rate.

Not available in this settingOffice (non-facility)
$573.07Hospital or facility

Check a contract rate as a % of Medicare · 25035 nationwide

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

We’ll open 25035 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Austin
  2. What 25035 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 25035 covers

This operation opens the outer layer of a forearm or wrist bone to reach an infected area, such as osteomyelitis or a bone abscess, for drainage or debridement. An orthopedic surgeon typically performs it in a hospital or ambulatory surgery setting. The target is bone, not an abscess limited to soft tissue, a bursa, or a wrist joint.

Report the code when the operative work includes an incision through the bone cortex; document the affected bone, side, indication, and the work performed. It 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 at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; 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.

How Austin compares for 25035

Across 109 of 109 payment localities, the facility rate for 25035 runs from $500.89 in Arkansas to $681.69 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). Austin pays $573.07. The RVUs are the same everywhere; the geographic indexes change the dollars.

25035 in Austin vs other payment areas
  1. Austin · this page$573.07
  2. Beaumont · Texas$536.20−$36.87
  3. Brazoria · Texas$551.43−$21.64
  4. Dallas · Texas$557.13−$15.94
  5. Fort Worth · Texas$555.21−$17.86
  6. Galveston · Texas$554.50−$18.57
  7. Houston · Texas$583.61+$10.54

Other areas in Texas first, then benchmark localities. Bars start at $0.

Every other payment area

25035 in every other Medicare payment locality
Payment localityOfficeFacility
Rest Of TexasTexas—$545.00
Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)California—$603.64
Dc + Md/Va SuburbsDistrict of Columbia—$629.42
MiamiFlorida—$655.38
ChicagoIllinois—$635.30
ManhattanNew York—$652.85
Alaska*Alaska—$681.19
AlabamaAlabama—$507.78

25035 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
25035 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

See 25035 in every payment locality

How the 25035 rate is calculated

Each of 25035’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 · 25035

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 7.46Practice expense 7.82Malpractice 1.59

16.8700 adjusted RVUs×$33.4009 conversion factor=$563.47

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

The exact Austin inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

2,376

Code
25035
Physician work
7.46
Practice expense
7.82
Malpractice
1.59

GPCI2026.csv

96

Locality
Austin
Physician work
1.002
Practice expense
1.058
Malpractice
0.886
Facility calculation for 25035 in Austin
ComponentRVULocality factorAdjusted
Physician work7.46× 1.0027.4749
Practice expense7.82× 1.0588.2736
Malpractice1.59× 0.8861.4087
Total RVUs17.1572
Conversion factor× 33.4009

Facility rate, Austin$573.07

Facility: (7.46 × 1.002 + 7.82 × 1.058 + 1.59 × 0.886) × $33.4009 = $573.07

Open 25035 in the RVU calculator

Payment rules and modifiers for 25035

25035 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 25035

Bone incision

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)0Not paid without supporting documentation.
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 · 25035

Bone incision

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 50 · payment effect

With and without the modifier

25035 without 50 · national facility

$563.47

Bone incision

25035-50 · Bilateral: 150%

$845.21

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

Codes related to 25035

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

Codes related to 25035
CodeHow it relatesOffice range, Austin
Used instead
25028Collection drainageTargets a deep forearm or wrist soft-tissue abscess or hematoma rather than infected bone.No office rate
25031Bursal drainageApplies when the operative target is a forearm or wrist bursa.No office rate
25040Wrist arthrotomyApplies to an operation directed at the wrist or midcarpal joint rather than bone cortex.No office rate

How 25035 has changed in Austin

25035 · Office / nonfacility

Rate unavailable

Effective 2026-10-01

A rate is unavailable in one of these releases, so a change cannot be calculated.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release
Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01Not available in this setting$573.07RVU26D
2026-07-01Not available in this setting$573.07RVU26C
2026-04-01Not available in this setting$573.07RVU26B
2026-01-01Not available in this setting$573.07RVU26A
2025-10-01Not available in this setting$597.40RVU25D
2025-07-01Not available in this setting$597.40RVU25C
2025-04-01Not available in this setting$597.40RVU25B
2025-01-01Not available in this setting$597.40RVU25A

Price 25035 for an earlier date of service

Where the Austin rate applies

Austin is a Medicare payment area, not a city. Our Census mapping connects it to 31 cities and communities in Texas. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Texas

25035 billing questions

When is this code preferable to a deep forearm or wrist abscess drainage code?

Use this code when the surgeon opens the bone cortex to address infected bone. A deep soft-tissue abscess without bone work points to a soft-tissue drainage code instead.

Does it describe drainage of a wrist joint or bursa?

No. The target is bone cortex; a procedure directed at the wrist joint or a bursa is coded according to that structure and the work performed.

What documentation supports reporting it?

Document the affected forearm or wrist bone, laterality, the bone infection or abscess being treated, and the cortical incision and work performed.

How does the 90-day global period affect postoperative billing?

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

How is it paid when other procedures are performed in the same session?

The highest-valued procedure is paid in full, and other procedures are paid at 50%. Bilateral reporting with modifier 50 is paid at 150%.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment requires documentation of medical necessity. 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 25035PPRRVU2026_Oct_nonQPP.csv, line 2,376 (RVU26D)
Geographic factors for AustinGPCI2026.csv, line 96 (RVU26D)

Open CMS sourceHow we calculate rates

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