Billing code 25126: Bone lesion surgeryMedicare rate & RVUs in Illinois
Reports curettage or excision of a benign bone lesion in the radius or ulna when the resulting defect is filled with allograft.
CMS doesn’t publish an office rate for 25126 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.
On this page 9 sections
What 25126 covers
This procedure treats a bone cyst or benign tumor in the radius or ulna by removing or curetting the lesion and filling the resulting bone defect with donor bone graft. An orthopedic or hand surgeon typically performs it in an operating room. The operative report should identify the affected bone, describe the lesion removal, and document that allograft was used to fill the defect.
Select this code for the radius or ulna when allograft is used; the no-graft and autograft versions are separate codes. The 90-day global period includes 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 other procedures are subject to the standard 50% reduction. For bilateral reporting with modifier 50, CMS pays at 150%. 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 25126 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 | Unavailable | $647.24 |
| East St. Louis | Unavailable | $607.54 |
| Rest Of Illinois | Unavailable | $581.41 |
| Suburban Chicago | Unavailable | $625.03 |
How the 25126 rate is calculated
Each of 25126’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 · 25126
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 7.55Practice expense 8.04Malpractice 1.61
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 25126
25126 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 25126
Bone lesion surgery
| 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) | 2 | Paid. |
| 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 · 25126
Bone lesion surgery
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
25126 without 50 · national facility
$574.50
Bone lesion surgery
25126-50 · Bilateral: 150%
$861.75
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).
25126 compared with similar codes
Compare codes
25126 vs 25120 vs 25125 vs 25135: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 25120Bone lesion removal
- Both address qualifying bone lesions of the radius or ulna, but 25120 is for treatment without graft; 25126 includes allograft.
- 25125Bone lesion excision
- Both include grafting after radius-or-ulna lesion treatment. Choose 25125 for autograft and 25126 for allograft.
- 25135Bone lesion surgery
- This code concerns a carpal bone and autograft, while 25126 concerns the radius or ulna and allograft.
25126 billing questions
How does this differ from 25125?
Use 25126 when the defect is filled with allograft. Code 25125 describes the corresponding procedure using autograft.
When is 25120 more appropriate?
Use 25120 for qualifying lesion removal or curettage in the radius or ulna when no graft is used. Code 25126 includes allograft use.
What documentation supports 25126?
Document the radius or ulna involved, the bone cyst or benign tumor treatment, and use of allograft to fill the defect.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other same-session procedures paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. CMS pays bilateral reporting with modifier 50 at 150%.
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
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