Billing code 25275: Tendon repairMedicare rate & RVUs in Illinois
Reports repair of an extensor tendon at the forearm or wrist when the procedure includes transplantation of the tendon sheath.
CMS doesn’t publish an office rate for 25275 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 25275 covers
An orthopedic or hand surgeon uses this service to repair an extensor tendon in the forearm or wrist while transplanting or reconstructing its sheath. The sheath work distinguishes the procedure from a repair limited to tendon tissue. It is generally performed in an operating room for an injury or other tendon problem requiring both tendon repair and sheath reconstruction.
Select the code when the operative report supports extensor tendon repair with tendon sheath transplantation; document the affected side, tendon, and work performed. 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 the others at 50%. Modifier 50 identifies a bilateral procedure, paid at 150%. Assistant-at-surgery payment requires medical-necessity documentation, and co-surgeon payment requires supporting documentation; team surgery is 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 25275 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 | $699.16 |
| East St. Louis | Unavailable | $658.03 |
| Rest Of Illinois | Unavailable | $631.08 |
| Suburban Chicago | Unavailable | $676.24 |
How the 25275 rate is calculated
Each of 25275’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 · 25275
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 8.74Practice expense 8.28Malpractice 1.66
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 25275
25275 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 25275
Tendon repair
| 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) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| 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 · 25275
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
25275 without 50 · national facility
$623.93
Tendon repair
25275-50 · Bilateral: 150%
$935.89
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).
25275 compared with similar codes
Compare codes
25275 vs 25274 vs 25270 vs 25272 vs 25295: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 25274Tendon repair
- Choose 25275 when the extensor tendon repair includes tendon sheath transplantation. Choose 25274 for repair with a free tendon graft.
- 25270Extensor tendon repair
- 25270 describes primary extensor tendon repair without the sheath-transplantation feature. The sheath transplantation is the distinguishing work for 25275.
- 25272Tendon repair
- 25272 describes secondary extensor tendon repair without the sheath-transplantation feature. Report 25275 when the repair includes tendon sheath transplantation.
- 25295Tendon release
- 25295 addresses release of a tendon to free it from adhesions. It is not the tendon repair with sheath transplantation represented by 25275.
25275 billing questions
How is this different from 25274?
25275 is for extensor tendon repair that includes tendon sheath transplantation. Use 25274 when the repair uses a free tendon graft rather than the sheath-transplantation service.
Can the tendon repair and sheath work be reported separately?
The defining service includes extensor tendon repair with tendon sheath transplantation. The operative report should establish that combination rather than describe tendon repair alone.
What documentation supports reporting 25275?
Document the forearm or wrist site, the extensor tendon repaired, and the tendon sheath transplantation or reconstruction performed. The operative note should make clear how the sheath work was part of the repair.
How is a bilateral procedure reported?
Use modifier 50 for a bilateral procedure; CMS pays the bilateral service at 150%.
Can an assistant surgeon or co-surgeon be paid?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeon payment requires supporting documentation, and team surgery is 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
Fee sheets
Put 25275 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 →