Soft tissue repair · Elbow

24116

Excision or curettage of a bone cyst or benign tumor of the humerus with allograft reconstruction

Verified May 8, 2026 · 5 sources ↓

Medicare
$797.95
Total RVUs
23.89
Global, days
90
Region
Elbow
Drawn from CMSBedrockbillingAAOSAoassn

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

  • Specify the lesion type (bone cyst vs. benign tumor) and its location on the humerus (proximal, diaphyseal, distal)
  • Confirm use of allograft, not autograft — operative note must name the graft source and type (e.g., cancellous allograft, structural allograft)
  • Document lesion dimensions and extent of osseous defect requiring reconstruction
  • Record approach used and any osteotomy performed for exposure (e.g., olecranon osteotomy for distal humeral access)
  • Include pathology submission confirmation or intraoperative gross description supporting benign characterization
  • Note any fixation hardware placed if structural allograft required stabilization

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 24116 covers surgical removal or curettage of a bone cyst or benign tumor of the humerus combined with allograft bone graft placement to fill the resulting defect. The allograft component is what distinguishes this code from 24110 (excision without grafting) and 24115 (excision with autograft). Using the wrong code in that trio is the most common coding error on these cases.

The 90-day global period covers all routine post-op care through day 90, including wound checks, cast or splint changes, and imaging that's part of routine follow-up. Any E/M visit for a new or unrelated problem during that window requires modifier 24. A staged or planned second procedure within the global needs modifier 58.

This procedure carries a meaningful facility vs. non-facility rate differential — see the Site of Service comparison on this page. When performed at an ASC vs. HOPD, the payment difference is substantial and drives prior authorization strategy for many commercial payers.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU11.92
Practice expense RVU9.43
Malpractice RVU2.54
Total RVU23.89
Medicare national rate$797.95
Global period90 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

SettingMedicare rate (national)
Office (PFS non-facility)
Procedure performed in physician's office
$797.95
HOPD (APC 5114)
Hospital outpatient department
$7,413.38
ASC (PI J8)
Ambulatory surgical center (freestanding)
$4,682.29

Common denial reasons

The recurring reasons claims for CPT 24116 get rejected.

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

  • Upcoding flag when 24110 (no graft) or 24115 (autograft) better matches the operative note — payers audit graft source language
  • Missing allograft documentation: if the op note doesn't explicitly name the allograft, payers default to downcode to 24110
  • Medical necessity denial when pre-op imaging or pathology report is absent from the claim record
  • Bundling conflict if 24105 (olecranon bursa excision) or other elbow codes are billed same-day without modifier 59 or XS
  • Global period violation when routine post-op visit is billed without modifier 24 during the 90-day window

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What's the difference between 24110, 24115, and 24116?
Graft type drives the code selection. 24110 is excision or curettage with no bone graft. 24115 adds an autograft (bone taken from the patient). 24116 uses allograft (donor bone). If your op note doesn't clearly name the graft source, expect a downcode to 24110.
02Can I bill separately for the allograft material with 24116?
The allograft procedure is bundled into 24116. Allograft tissue itself (the implant cost) may be separately reportable as a supply using the appropriate HCPCS code depending on payer policy — check individual payer contracts and your facility's charge capture process.
03If an olecranon osteotomy was performed for exposure, does that get billed separately?
Generally no. An osteotomy performed solely for surgical exposure is part of the surgical approach and bundles into the primary procedure. Document it in the operative note, but don't bill it as a standalone code unless it required separate, distinct work beyond access.
04Is modifier 62 (co-surgery) appropriate for 24116?
Modifier 62 applies when two surgeons of different specialties each perform a distinct portion of the procedure and each dictates their own operative note. If one surgeon performs the tumor excision and another performs the allograft reconstruction as equal co-surgeons, modifier 62 is supportable. Both operative notes must document each surgeon's distinct contribution.
05What does the 90-day global period cover for this case?
The global covers the day before surgery, the surgery itself, and all routine post-op visits, wound care, splint or cast changes, and related imaging through day 90. Bill modifier 24 on any E/M for a problem unrelated to the elbow tumor surgery during that window. Use modifier 58 for a staged procedure that was planned at the time of the original surgery.
06Is prior authorization typically required for 24116?
Most commercial payers require prior auth for this procedure given its complexity and facility cost. Auth requirements vary by payer. Submit pre-op imaging, pathology or biopsy results, and the treatment plan — auth denials for this code are commonly tied to insufficient clinical documentation at the time of the request.

Sources & references

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

  1. 01CMS Physician Fee Schedule 2026
  2. 02
    cms.gov
    https://www.cms.gov/files/document/2025nccimedicarepolicymanualcompletepdf.pdf
  3. 03
    bedrockbilling.com
    https://bedrockbilling.com/static/cci/24116
  4. 04
    aaos.org
    https://www.aaos.org/education/about-aaos-products/coding-resources/
  5. 05
    aoassn.org
    https://www.aoassn.org/wp-content/uploads/2020/12/CodingTTP.pdf

Mira AI Scribe

Mira's AI scribe captures the lesion type, anatomic location on the humerus, graft type (allograft confirmed), defect dimensions, and surgical approach directly from dictation. This prevents the most common audit flag on 24116: an op note that describes the procedure but fails to explicitly document allograft use, which triggers a downcode to 24110 on review.

See how Mira captures CPT 24116 documentation

Related CPT codes

24620 $567.82
Closed treatment of a Monteggia fracture-dislocation at the elbow — proximal ulna fracture combined with radial head dislocation — performed with manipulation and without surgical incision.
21282 $369.41
Surgical tightening and reattachment of the lateral canthal tendon to restore the outer corner of the eyelid to its correct anatomical position.
27646 $1,389.81
Radical resection of a tumor from the fibula, including removal of wide margins of surrounding normal bone and soft tissue.
26432 $542.76
Closed repair of a finger extensor tendon at its distal insertion — the mallet finger procedure — using splinting with or without percutaneous pin fixation.
Ready?

Ready to transform your orthopedic practice?

See how orthopedic practices are running documentation, billing, and operations on a single voice-first platform.

Get started for free