Surgical · Elbow

Excision or curettage of a bone cyst or benign tumor at the radial head, neck, or olecranon process, with autograft harvested from the patient at the same operative session.

Verified May 8, 2026 · 5 sources ↓

Medicare: $594.54
Work RVU: 7.94
Global, days: 90
Region: Elbow

Drawn from CMSEmednyEatonhand

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 exact anatomic location of the lesion: radial head, radial neck, or olecranon process
Confirm pathologic diagnosis or presumptive diagnosis supporting benign or cystic nature of the lesion
Document that autograft was harvested intraoperatively and specify the donor site
Describe the curettage or excision technique and extent of bone defect created
Include preoperative imaging (X-ray, MRI, or CT) corroborating the lesion location and size
Operative note must name the approach — generic terms like 'standard approach' are an audit flag

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 51 Multiple procedures 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 24125 covers surgical removal or curettage of a bone cyst or benign tumor located at the radial head or neck, or the olecranon process of the elbow, where the resulting defect is filled with autogenous bone graft harvested during the same procedure. The autograft harvest is included — do not separately report a graft procurement code. This distinguishes 24125 from 24120 (no graft) and 24126 (allograft).

The 90-day global period applies. Routine post-op visits, dressing changes, and implant checks through day 90 are bundled. Any visit for an unrelated problem during that window requires modifier 24. A staged or related return to the OR within the global period requires modifier 78; an unrelated return requires modifier 79.

Site of service matters here. HOPD and ASC payments differ substantially — see the Site of Service comparison table. When billing in a facility setting, the surgeon bills the professional component only; the facility captures the technical component separately.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (7.94) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.8) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.94
Practice expense RVU	8.17
Malpractice RVU	1.69
Total RVU	17.8
Medicare national rate	$594.54
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	$594.54
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 24125 get rejected.

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

Billing 24125 and a separate graft harvest code — autograft procurement is bundled into this code
Missing or vague pathology documentation that fails to confirm benign or cystic lesion
Wrong anatomic site coded — 24125 is for radial head/neck or olecranon only; humerus lesions fall under 24115
Unbundling 24125 from 24120 without clear documentation justifying a distinct, separately billable service
E/M visit billed same-day without modifier 25 when a separate, significant decision-making encounter is documented

Frequently asked questions

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

01Is the autograft harvest separately billable with 24125?

No. Autograft procurement is included in 24125. Billing a separate graft harvest code alongside it will trigger a bundling denial. If allograft is used instead, switch to 24126.

02What is the global period for 24125?

90 days. All routine post-op care, dressing changes, and follow-up visits related to the procedure are bundled through day 90. Use modifier 24 for unrelated E/M visits and modifier 78 for unplanned related returns to the OR within that window.

03How does 24125 differ from 24120 and 24126?

24120 is excision or curettage at the same anatomic site without any graft. 24125 adds autograft harvested from the patient. 24126 uses allograft. Select based on what was actually placed — the operative note must confirm it.

04Can 24125 be billed bilaterally?

Bilateral elbow lesions at the same site are rare, but if performed, append modifier 50. Reimbursement is capped at 150% of the single-procedure fee schedule amount under most payers.

05What ICD-10 diagnoses support 24125?

Common supporting diagnoses include unicameral bone cyst (M85.42x for radial site), aneurysmal bone cyst (M85.52x), and benign neoplasm of bone at the elbow (D16.12). Diagnosis must match the documented pathology and anatomic site.

06Should modifier 22 ever be used with 24125?

Use modifier 22 when the procedure is substantially more work than typical — for example, an unusually large lesion requiring extended curettage or complex graft contouring. Document the extra time, difficulty, and clinical rationale in the operative note. Payers will request records.

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's exact anatomic site (radial head, radial neck, or olecranon), confirms autograft harvest language and donor site, and flags when graft procurement is documented as a separate procedure — preventing erroneous unbundling denials. It also records the benign or cystic characterization required to support the ICD-10 diagnosis, keeping your operative note audit-ready from the first draft.

See how Mira captures CPT 24125 documentation