Billing code 25115: Lesion excisionMedicare rate & RVUs in Ohio
Surgical removal of a wrist or forearm lesion is reported when the operative service matches this code’s procedure and anatomic scope.
CMS doesn’t publish an office rate for 25115 in Ohio.
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 25115 covers
This code represents an operation to remove a lesion in the wrist or forearm. It is typically performed by an orthopedic or hand surgeon in an operating room or, when appropriate, an office procedure setting. The operative report should identify the lesion’s location and the tissues involved, and describe the work performed. A wrist or forearm location alone is not enough to distinguish this service from excision of a tendon-sheath lesion, a joint procedure, or removal of a bone lesion.
Report the code when the documented operation matches its specific procedure, rather than selecting it from the lesion’s general location or diagnosis alone. Include the operative findings and the anatomic site in the record to support code selection. CMS assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. For bilateral reporting with modifier 50, CMS pays at 150%. CMS does not pay an assistant at surgery for this code; 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.
25115 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $676.78 |
How the 25115 rate is calculated
Each of 25115’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 · 25115
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 9.84Practice expense 9.34Malpractice 1.88
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 25115
25115 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 25115
Lesion excision
| 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) | 1 | Not paid (statutory restriction). |
| 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 · 25115
Lesion excision
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
25115 without 50 · national facility
$703.42
Lesion excision
25115-50 · Bilateral: 150%
$1,055.13
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).
25115 compared with similar codes
Compare codes
25115 vs 25116 vs 25111 vs 25120: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 25116Tumor resection
- The codes describe closely related wrist or forearm lesion operations. Use the full descriptor and operative details to determine which procedure was performed.
- 25111Wrist ganglion excision
- This code is for a wrist tendon-sheath or joint-capsule lesion, such as a ganglion. Choose it when that structure and procedure are documented rather than relying on the broader site description.
- 25120Bone lesion removal
- This code concerns a bone cyst or benign tumor of the radius or ulna. It is distinct from excision of a lesion in other wrist or forearm tissues.
25115 billing questions
How do I distinguish this code from 25116?
Both concern a wrist or forearm lesion, so use the full code descriptions and the documented operation to identify the applicable code. Do not select between them based on site alone.
When is a tendon-sheath lesion code more appropriate?
Use the code that specifically describes excision of a tendon-sheath or joint-capsule lesion when the operative report identifies that structure as the target. A general wrist or forearm location does not establish that this code applies.
Is related postoperative care separately reported?
Related postoperative care during the 90-day global period is included. CMS also includes the day-before preoperative visit in that global period.
How does CMS handle other procedures performed in the same session?
The highest-valued procedure is paid in full and the other procedures are paid at 50% under the standard multiple procedure reduction.
Can I report an assistant or co-surgeon for this operation?
CMS does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What documentation supports reporting this code?
Document the wrist or forearm site, the lesion’s anatomic location and involved tissues, and the operative work performed. These details help distinguish the service from tendon-sheath, joint, and bone procedures.
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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