CPT 25260 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Repair, Revision, and/or Reconstruction Procedures on the Forearm and Wrist Surgical Procedures on the Forearm and Wrist |
| Common Place of Service | 21 - Inpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None LT - Left side of body RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 25260 |
National average reimbursement for CPT 25260 by major payers:
$896.45
$891.76
$915.99
$1,104.65
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 25260 | $1400.00 | 1831636752 - RIVER VIEW SURGERY CENTER, LLC | 814790945 - (ID) RIVER VIEW SURGERY CENTER, LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25260 | $2277.00 | 1326469172 - EHI SURGERY CENTER AUSTIN, LLC | 464266877 - (TX) EHI SURGERY CENTER AUSTIN LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25260 | $864.00 | 1427051796 - SOUTH BEND IN ENDOSCOPY ASC LLC, MICHIANA ENDOSCOPY CENTER | 352011366 - (IN) SOUTH BEND IN ENDOSCOPY ASC LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25260 | $16288.00 | 1528069218 - NORTHSHORE REGIONAL MEDICAL CENTER DBA THE SURGERY SUITE, THE SURGERY SUITE | 720502505 - (LA) OCHSNER CLINIC FOUNDATION | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25260 | $2122.00 | 1962402503 - NORTH KITSAP AMBULATORY SURGERY CENTER, LLC, PACIFIC SURGERY CENTER | 911276412 - (WA) NORTH KITSAP AMBULATORY CENTER, INC. DBA PACIFIC SURGERY CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25260 | $3347.00 | 1942851639 - NORTHERN MICHIGAN SURGICAL SUITES, LLC | 830670803 - (MI) NORTHERN MICHIGAN SURGICAL SUITES, LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25260 | $1072.50 | 1821112145 - SCRIPPS ENCINITAS SURGERY CENTER, LLC | 205942958 - (CA) SCRIPPS ENCINITAS SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25260 | $576.00 | 1699286922 - HUMBLE VASCULAR SURGICAL CENTER LLC | 820905971 - (TX) HUMBLE VASCULAR SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25260 | $1072.50 | 1497834931 - VISION CARE CENTER, A MEDICAL GROUP INC, EYE-Q SURGERY CENTER | 941717441 - VISION CARE CENTER, A MEDICAL GROUP, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25260 | $2435.00 | 1609871847 - THE SURGERY CENTER, LLC | 582520623 - (GA) THE SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25260 | $576.00 | 1396277208 - ELITE SURGERY CENTER, LLC | 820836081 - (CA) ELITE SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25260 | $1072.50 | 1689699597 - NAPA SURGERY CENTER LLC | 680366295 - (CA) NAPA SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25260 | $1307.00 | 1447271713 - COLUMBUS ORTHOPEDIC OUTPATIENT | 900069344 - (MS) COLUMBUS ORTHOPEDIC OUTPATIENT | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25260 | $576.00 | 1114483492 - ORANGE COUNTY DIGESTIVE CENTER, INC | 832144265 - (CA) ORANGE COUNTY DIGESTIVE CENTER, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25260 | $6734.00 | 1275536393 - MEDICAL CENTER SURGERY ASSOCIATES, LP | 621449272 - (FL) MEDICAL CENTER SURGERY ASSOCIATES LP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 25260 vs. Other Surgical Procedures on the Forearm and Wrist Codes
The CPT 25260 code is part of the Repair, Revision, and/or Reconstruction Procedures on the Forearm and Wrist services used for Surgical Procedures on the Forearm and Wrist. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 25260 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 25260-CPT | Moderate | Repair Forearm Tendon Muscle, Repair Tendon Or Muscle Flexor Forearm And Or Wrist Primary Single Each Tendon Or Muscle |
| 25263-CPT | Moderate | Repair Forearm Tendon Muscle, Repair Tendon Or Muscle Flexor Forearm And Or Wrist Secondary Single Each Tendon Or Muscle |
| 25265-CPT | High | Tendon Or Muscle Repair Of Arm, Surgery To Repair A Torn Tendon Or Muscle In The Lower Arm Or Wrist. When The Repair Is More Than 10 Days After An Injury (Or The First Procedure Failed To Restore Mobility) A Graft May Be Necessary To Bring The Ends Together. |
| 25310-CPT | Moderate | Move Tendon In Arm Or Wrist, Surgery To Remove Either The Flexor Or Extensor Tendon From Its Attachment And Transfer It Onto Another Tendon In The Lower Arm Or Wrist. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25260. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25260 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 25260) and we'll show you how you compare in 15 minutes or less.