No office rate
Choose 25260 for primary repair of a flexor tendon or muscle; choose 25263 for a primary extensor repair.
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CMS RVU26D · Effective 2026-10-01
25263 Tendon repair Medicare reimbursement rates in Idaho
Reports primary repair of a single extensor tendon or muscle in the forearm or wrist, such as direct repair after an acute injury. Compare 25263 office and facility rates across CMS payment localities in Idaho.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 25263 in Idaho?
Idaho has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$555.28
1 of 1 localities have a supported rate.
Payment area: Idaho
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Orthopedic surgery
About 25263: Primary extensor tendon or muscle repair
Reports primary repair of a single extensor tendon or muscle in the forearm or wrist, such as direct repair after an acute injury.
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.
CMS billing rules for 25263
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU7.84 · 43%
- Practice expense (office) RVU8.69 · 48%
- Malpractice RVU1.67 · 9%
106
Medicare services in 2024 · #4832 by national volume
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.
25263 compared with similar codes
Office rates for Idaho, from the same CMS release.
No office rate
25265 describes secondary repair of a flexor tendon or muscle. It is not the primary extensor repair represented by 25263.
No office rate
25270 is for secondary repair of an extensor tendon or muscle. Use 25263 for primary repair.
No office rate
25272 is a secondary extensor repair code involving a free graft; 25263 describes primary repair.
Compare 25263 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Idaho →
Office / nonfacility
Unavailable
Facility
$555.28
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 25263 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
2,419
- Code
- 25263
- Physician work
- 7.84
- Practice expense
- 8.69
- Malpractice
- 1.67
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.84 | × 1.000 | 7.8400 |
| Practice expense | 8.69 | × 0.920 | 7.9948 |
| Malpractice | 1.67 | × 0.473 | 0.7899 |
| Total RVUs | 16.6247 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Idaho$555.28
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.84 | 1 |
| Practice expense | 8.69 | 0.92 |
| Malpractice | 1.67 | 0.473 |
(7.84 × 1 + 8.69 × 0.92 + 1.67 × 0.473) × $33.4009 = $555.28
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
2,41625251,,Removal of wrist prosthesis,A,,9.57,8.67,NA,8.67,,2.05,20.29,20.29,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,41725259,,Manipulate wrist w/anesthes,A,,3.94,8.36,NA,8.36,,0.79,13.09,13.09,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,41825260,,Repair forearm tendon/muscle,A,,7.84,8.59,NA,8.59,,1.51,17.94,17.94,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,41925263,,Repair forearm tendon/muscle,A,,7.84,8.69,NA,8.69,,1.67,18.20,18.20,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,42025265,,Repair forearm tendon/muscle,A,,9.85,8.91,NA,8.91,,1.84,20.60,20.60,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,42125270,,Repair forearm tendon/muscle,A,,6.02,6.89,NA,6.89,,1.19,14.10,14.10,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,42225272,,Repair forearm tendon/muscle,A,,7.03,7.53,NA,7.53,,1.48,16.04,16.04,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772