Excision or curettage of a bone cyst or benign tumor of the radial head or neck at the elbow, including any allograft filling of the resulting defect.

Verified May 8, 2026 · 6 sources ↓

Medicare: $617.58
Work RVU: 8.4
Global, days: 90
Region: Elbow

Drawn from CMSAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative note must identify the lesion as a cyst or benign tumor located specifically at the radial head or neck, not the radial shaft or capitellum
Document that allograft was used to fill the bony defect, including graft source and approximate volume or configuration
Specify surgical approach by name — do not write 'standard approach'; audit reviewers flag generic language
Pre-operative imaging (X-ray or MRI) confirming the lesion location, size, and characteristics should be in the record
Pathology specimen submission and report confirming benign histology is expected by most payers
If modifier 22 is appended, the operative note must describe specifically what made the work substantially greater than typical — altered anatomy, extensive curettage, unexpected lesion size

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 50 Bilateral procedure 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 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 6 cited references ↓

CPT 24126 covers surgical removal or scraping out of a bone cyst or benign tumor located at the radial head or neck, with allograft used to pack the cavity left behind. This is an open elbow procedure — not arthroscopic — and the allograft component is integral to the code, not separately billable. If autograft is used instead, or if a different graft type changes the operative work substantially, document that distinction clearly; payers may scrutinize graft sourcing.

The 90-day global period means all routine post-op care through day 90 is bundled. Any E/M visit on the day before or day of surgery where the decision to operate is made requires modifier 57 on the E/M code. Unrelated problems managed during the global period need modifier 24. If a separate unrelated procedure is performed during the global, use modifier 79.

Site of service matters here: HOPD and ASC payments differ significantly (see the Site of Service comparison table on this page). If the procedure is performed bilaterally — rare for a radial head lesion but possible in systemic bone disease — modifier 50 applies. Document laterality in both the operative note and on the claim.

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 (8.4) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (18.49) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.4
Practice expense RVU	8.31
Malpractice RVU	1.78
Total RVU	18.49
Medicare national rate	$617.58
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	$617.58
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 24126 get rejected.

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

Lesion location not documented as radial head or neck — vague anatomy pushes payers to downcode or deny
Allograft not documented, leading payers to question whether 24126 (with allograft) is the correct code versus 24125 (without graft)
Missing pathology report or pre-operative imaging to support medical necessity of excision
E/M billed same-day without modifier 25 to demonstrate a separately identifiable evaluation occurred
Claim submitted during the 90-day global of a prior elbow procedure without a global-period modifier, triggering automatic bundling denial

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What is the difference between CPT 24125 and 24126?

24125 covers excision or curettage of a radial head/neck bone cyst or tumor without a graft or with autograft only. 24126 requires allograft to fill the defect. Using the wrong code based on graft source is a common audit finding — document graft type explicitly in the operative note.

02Can I bill the allograft separately when using 24126?

No. The allograft is integral to 24126 and is not separately reportable. The code bundles the graft work. Bill supplies per your facility's normal supply/implant cost reporting process, but do not add a separate graft CPT alongside 24126.

03What modifier do I use if I make the surgical decision the day before the procedure?

Append modifier 57 to the E/M code — not to 24126. Modifier 57 signals that the decision for a major surgery (90-day global) was made at that visit. CMS recognizes the day before or day of surgery for modifier 57 applicability.

04Is modifier 50 appropriate if the same lesion type is treated at both elbows in the same session?

Yes. If bilateral radial head/neck lesions are excised with allograft in the same operative session, bill 24126 with modifier 50. Confirm bilateral pathology is documented — symmetric systemic bone disease is the typical scenario. Laterality must also appear on the claim (LT/RT if the payer requires individual line items instead of modifier 50).

05How do I handle a return to the OR for a wound complication after 24126?

If the return is for a complication related to the original procedure, use modifier 78 on the subsequent procedure code. Modifier 78 does not reset the global period clock. If the return is for a completely unrelated problem, use modifier 79, which does reset the global.

06Does 24126 carry a 90-day global period and what does that include?

Yes, 24126 has a 90-day global. That window covers the day-before visit, the surgery itself, and all routine follow-up care through post-op day 90 — dressing changes, suture removal, standard imaging checks. Anything outside routine post-op care or unrelated to the elbow procedure requires a global-period modifier to be separately payable.

Sources & references

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

Mira Scribe

Mira's AI scribe captures lesion location (radial head vs. neck), graft type (allograft confirmed), approach name, and curettage extent from dictation in real time. This prevents the most common 24126 denial: a note that doesn't distinguish allograft use or fails to pin the lesion to the radial head or neck specifically, both of which trigger downcoding to 24125 or outright denial.

See how Mira captures CPT 24126 documentation