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See a sample rate comparisonCPT 25265 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
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.
| 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 LT - Left side of body RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 25265 |
| Medicaid Fee Schedule | View Medicaid rates for 25265 |
National average reimbursement for CPT 25265 by major payers:
$1,035.39
$1,052.99
$1,037.10
$1,266.37
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CPT 25265
5 of 25 sample ratesHigher to lower in this preview
Texas Health Harris Methodist Hospital Azle
$11,871.00Published rateAdvanced Surgical Care Of Clearwater LLC
$3,623.00Published rateSunset Surgical Centre LLC
$2,240.00Published rateCardiovascular Surgical Suites LLC
Cardiovascular Surgical Suites L
$1,437.00Published rateVision Surgical Center At Springhill Psc
$643.00Published rate
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See a sample payer proposalCPT 25265 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25265 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 25265 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. |
| 25312-CPT | Moderate | Transplant Forearm Tendon, Tendon Transplantation Or Transfer Flexor Or Extensor Forearm And Or Wrist Single With Tendon Graft S Includes Obtaining Graft Each Tendon |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25265. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25265 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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