Surgical removal of the radial head at the elbow, performed through an open approach to the joint.

Verified May 8, 2026 · 5 sources ↓

Medicare: $485.32
Total RVUs: 14.53
Global, days: 90
Region: Elbow

Drawn from CMSAAPCCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Operative report must name the surgical approach (lateral Kocher, Kaplan, or posterolateral) — notes that say 'standard approach' are audit flags.
Document the indication: fracture classification (Mason type), failed conservative management, or arthritic destruction with functional limitation.
Record intraoperative assessment of associated ligamentous structures (lateral collateral ligament, interosseous membrane) and whether the DRUJ was evaluated.
Specify the extent of resection — complete radial head excision versus partial — to justify 24130 versus any alternative code.
Pre-op imaging (X-ray, CT) confirming radial head pathology should be referenced in the operative note.
Neurovascular status of the posterior interosseous nerve documented as checked intraoperatively.

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 52 Reduced services 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 XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 24130 describes open excision of the radial head — the proximal articular end of the radius that forms the lateral aspect of the elbow joint. The procedure is most commonly indicated for comminuted or Mason Type III/IV radial head fractures where internal fixation is not viable, as well as post-traumatic arthritis or chronic pain with restricted motion attributable to radial head pathology. The surgeon opens the elbow laterally, removes the radial head while protecting the lateral collateral ligament complex and the posterior interosseous nerve, irrigates the joint, and closes in layers. A splint or sling is typically applied postoperatively.

The decision to excise rather than replace or fix the radial head depends heavily on associated injuries. Isolated radial head excision in the setting of an Essex-Lopresti lesion (disruption of the interosseous membrane and distal radioulnar joint) is contraindicated — proximal radial migration will follow. When concomitant procedures are performed at the same operative session (e.g., lateral collateral ligament repair, coronoid fixation), those are separately reportable with modifier 51 unless NCCI edits bundle them. The 90-day global period means all routine elbow follow-up through day 90 is included; unrelated E/M visits need modifier 24.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.26
Practice expense RVU	7.04
Malpractice RVU	1.23
Total RVU	14.53
Medicare national rate	$485.32
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	$485.32
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 24130 get rejected.

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

Missing or vague fracture classification in the diagnosis coding — S52.12x codes require specificity (type I/II/III, laterality, open vs. closed).
Global period violation: E/M billed within 90 days post-op without modifier 24 for an unrelated visit or modifier 25 on a same-day E/M.
Upcoding denial when operative note describes only partial excision or debridement rather than complete radial head removal.
NCCI bundling denial when arthrotomy (24000) or elbow arthroplasty codes are billed on the same date without appropriate modifier or distinct documentation.
Lack of medical necessity documentation when performed for chronic pain without documented failed conservative treatment or functional deficit.

Frequently asked questions

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

01Can 24130 and radial head arthroplasty (24366) be billed together?

No. They are mutually exclusive — you either excise or replace the radial head. Billing both on the same date for the same elbow will result in a denial. If the plan changed intraoperatively from excision to implant, bill only the arthroplasty code.

02Is 24130 ever billed bilaterally?

Bilateral radial head excision is anatomically rare but not impossible (e.g., rheumatoid arthritis). If performed bilaterally at the same session, bill two units with modifiers LT and RT. On a physician claim, append modifier 50; on an ASC claim, use separate claim lines with LT and RT per CMS Chapter 4 NCCI guidance.

03What modifier applies if an unplanned return to the OR is needed within the 90-day global to address elbow bleeding or wound complication related to 24130?

Use modifier 78. That signals an unplanned return to the operating room for a complication related to the original procedure within the global period. Modifier 79 is for unrelated procedures — don't use it here.

04Can I separately bill lateral collateral ligament repair (24343) performed at the same session as 24130?

Yes, if the ligament repair is a distinct, documented procedure — not just routine retraction and closure. Append modifier 51 to the secondary code. Confirm the NCCI PTP edit status for this pair before submitting, and ensure the operative note separately describes the ligament repair steps.

05What ICD-10 codes most commonly support 24130?

Radial head fractures (S52.12x series) are the most common indication — code to the highest specificity including laterality and fracture type. Post-traumatic elbow arthritis (M19.121/M19.122) and chronic elbow pain with documented structural pathology also support medical necessity when fracture is not the primary driver.

06Does modifier 22 apply if the surgeon encounters significant scarring or prior hardware from a previous ORIF?

Yes, if the complexity meaningfully increased operative time and work. Document the prior hardware or scarring explicitly in the operative note, state how it complicated the dissection, and include the additional time spent. Attach a cover letter to the claim explaining the increased complexity — most payers require that for modifier 22 to be honored.

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 surgical approach by name, Mason fracture classification, intraoperative nerve identification, ligament integrity assessment, and whether the excision was complete or partial — exactly the details that distinguish 24130 from adjacent codes and satisfy medical necessity review. That prevents the two most common denials: vague operative notes triggering downcoding and missing fracture specificity causing ICD-10 mismatches.

See how Mira captures CPT 24130 documentation