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See a sample rate comparisonCPT 25263 Fee Schedule
Last Verified: September 2026
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.
Repair Forearm Tendon Muscle, Repair Tendon Or Muscle Flexor Forearm And Or Wrist Secondary Single Each Tendon Or Muscle
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 25263 |
| Medicaid Fee Schedule | View Medicaid rates for 25263 |
National average reimbursement for CPT 25263 by major payers:
$892.54
$889.03
$885.86
$1,071.83
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CPT 25263
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Texas International Endoscopy Center, LLC, Texas International Endoscopy Center
$7,838.00Published rateCentrum Surgery Center Ltd
$2,771.00Published ratePacific Surgery Center
$1,644.00Published rateEye Care Surgery Center, Inc
Eye Care Surgery Center Inc
$1,319.00Published rateMarty Henderson
Deaconess Hospital Inc
$502.36Published rate
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See a sample payer proposalCPT 25263 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25263 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal System. 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 25263 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 25263. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25263 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.
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