Excision or curettage of a bone cyst or benign tumor of the humerus, with autograft harvested from the patient to fill the defect.

Verified May 8, 2026 · 8 sources ↓

Medicare: $693.07
Total RVUs: 20.75
Global, days: 90
Region: Elbow

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Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 8 cited references ↓

Pathology or imaging confirming the lesion is a cyst or benign tumor of the humerus, not a malignant neoplasm
Operative note specifying the curettage or excision technique and defect dimensions
Documentation of autograft harvest site and volume of graft material collected
Preoperative diagnosis with corresponding ICD-10 code (e.g., M85.x2 for solitary bone cyst, D16.x2 for benign bone neoplasm of humerus)
Laterality documented — left or right humerus — to support LT/RT modifier use
Surgeon attestation that graft material was harvested from the patient (not allograft) to justify 24115 over 24116

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 24115 covers surgical removal or curettage of a bone cyst or benign tumor from the humerus, combined with autogenous bone grafting — meaning the surgeon harvests graft material from the patient at the same operative session to pack the resulting defect. The autograft harvest is included in this code; don't separately bill a graft harvest code. The 090-day global period means all routine follow-up care for 90 days post-op is bundled.

Compare this to 24110 (excision without graft) and 24116 (same procedure but with allograft instead of autograft). If the graft source is a bone bank rather than the patient's own tissue, 24116 is the correct code. Picking the wrong variant is a common audit trigger.

Documentation must establish the lesion as a cyst or benign tumor — not a malignancy, which would route to different oncologic excision codes. The operative note needs to capture the harvest site, graft type, defect dimensions, and curettage technique to support medical necessity and distinguish this from a simple excision.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.87
Practice expense RVU	8.78
Malpractice RVU	2.1
Total RVU	20.75
Medicare national rate	$693.07
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$693.07
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 24115 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Wrong code selected — 24116 (allograft) billed when autograft was used, or vice versa
Separate graft harvest code billed in addition to 24115, triggering a bundling denial since harvest is included
Missing or inadequate pathology/imaging documentation to support benign lesion diagnosis, causing medical necessity denial
Laterality modifier absent when payer requires LT or RT for unilateral humerus procedures
Malignant diagnosis code paired with a benign tumor excision code, causing ICD-10 to CPT mismatch denial

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01Is the bone graft harvest separately billable with 24115?

No. The autograft harvest is bundled into 24115. Billing a separate graft harvest code alongside 24115 will trigger an NCCI bundling denial.

02What's the difference between 24115 and 24116?

24115 uses autograft — bone harvested from the patient. 24116 uses allograft from a bone bank. The graft source must be explicitly documented in the operative note; payers and auditors will check.

03When should modifier 22 be used with 24115?

Use modifier 22 when the procedure required substantially more work than typical — for example, a large or complex lesion requiring extensive reconstruction. The operative note must quantify the additional time, difficulty, or extent of resection. Without strong documentation, payers will ignore the modifier.

04Does 24115 carry a global period, and what does that mean for post-op E/M billing?

Yes — 24115 has a 90-day global period. All routine post-op office visits within 90 days are bundled. If you see the patient in the global period for an unrelated condition, append modifier 24 to the E/M code.

05Can 24115 be billed bilateral with modifier 50?

Bilateral humeral lesion excision with autograft at a single session is rare but coding-appropriate. Use modifier 50 and expect a 150% payment of the single-procedure allowable. Confirm bilateral payer policy before submitting — some require two line items with LT and RT instead.

06Which ICD-10 codes pair with 24115?

Common pairings include M85.x2 for solitary bone cyst of the humerus and D16.x2 for benign neoplasm of the humerus. The diagnosis must confirm a benign lesion. A malignant diagnosis code will generate a mismatch denial.

07Can 24115 be performed in an ASC?

Yes. The ASC payment rate differs from HOPD — see the Site of Service comparison table on this page. Confirm the facility has appropriate equipment for graft harvest before scheduling.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the lesion location on the humerus, harvest site and graft type (autograft vs. allograft), defect size, and curettage versus en bloc excision technique directly from surgeon dictation. That documentation prevents the two most common denials: wrong code selection between 24115 and 24116, and separate graft harvest billing that triggers NCCI bundling edits.

See how Mira captures CPT 24115 documentation