Surgical removal of dead, sequestered bone from the shaft or distal humerus in the setting of chronic osteomyelitis.

Verified May 8, 2026 · 7 sources ↓

Medicare: $703.09
Total RVUs: 21.05
Global, days: 90
Region: Elbow

Drawn from CMSAAOSAAPC

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Diagnosis of chronic osteomyelitis with confirmed sequestrum at the humeral shaft or distal humerus — specify the exact anatomic level in the operative note
Description of the sequestered bone segment: size, location, and degree of separation from viable cortex
Confirmation that soft tissue abscess drainage, if performed, was confined to the same operative field and is not being billed separately
Intraoperative culture and pathology specimen documentation if obtained, supporting medical necessity and ICD-10 specificity
If modifier 22 is appended, a separate letter quantifying the additional work beyond typical sequestrectomy (e.g., extensive debridement, prior surgeries, compromised vascularity)
Assistant surgeon role documented in the body of the operative note — payer name in the header is no longer sufficient for modifier 80 or AS

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 50 Bilateral procedure 51 Multiple procedures 57 Decision for surgery 58 Staged or related 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

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 24134 covers open sequestrectomy of the humeral shaft or distal humerus — the operative excision of necrotic bone that has separated from viable surrounding cortex due to chronic osteomyelitis. The surgeon debrides the dead segment, irrigates the cavity, and addresses any soft tissue involvement. Incision and drainage of a soft-tissue abscess in the same operative field is bundled into the sequestrectomy and is not separately reportable.

The code carries a 90-day global period. The day-before decision visit requires modifier 57 appended to the E/M code. Any unrelated E/M during the 90-day postoperative window needs modifier 24. A staged return for further debridement or bone grafting uses modifier 58 if planned and documented in the initial operative note; an unplanned return for a related complication uses modifier 78.

Site of service matters here. HOPD and ASC facility payments differ substantially — see the Site of Service comparison table on this page. When the case is performed bilaterally (rare for osteomyelitis but structurally possible), hospital outpatient billing uses a single line with modifier 50; ASCs use two separate lines with modifiers LT and RT per CMS NCCI policy.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.96
Practice expense RVU	8.97
Malpractice RVU	2.12
Total RVU	21.05
Medicare national rate	$703.09
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	$703.09
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 24134 get rejected.

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

Soft tissue I&D billed separately on the same claim — it is bundled into 24134 per NCCI policy
Missing or inadequate osteomyelitis diagnosis linkage; claim lacks an ICD-10 code specifying chronicity and site
E/M billed on the day of surgery without modifier 57 (major procedure, 90-day global) or without documentation of a separately identifiable decision for surgery
Modifier 22 appended without supporting documentation quantifying the substantially increased work
Bilateral reporting on two lines without LT/RT in the ASC setting, or with duplicate 50 modifier errors in the HOPD setting

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Can I bill separately for draining a soft tissue abscess at the same site as the sequestrectomy?

No. Incision and drainage of a soft-tissue abscess in the same operative field is bundled into 24134. Billing it separately will trigger an NCCI edit and denial.

02What modifier do I use if the surgeon decided to perform this procedure at today's E/M visit?

Append modifier 57 to the E/M code. CPT 24134 carries a 90-day global, so any decision-for-surgery E/M on the day of or day before the procedure requires modifier 57 to be payable.

03The patient returns within the 90-day global for a second debridement that was planned. How do I bill?

Use modifier 58 on the return procedure code. Document the intent for staged debridement in the original operative note. Modifier 58 resets the global period clock.

04What if the patient develops an unrelated fracture and needs surgery during the 90-day global?

Append modifier 79 to the unrelated procedure. Modifier 79 signals an unrelated procedure during the postoperative period — do not use modifier 78, which is reserved for unplanned returns for a related complication.

05Is fluoroscopy separately billable if used intraoperatively during this procedure?

Only if it is not described as included in the procedure by CPT instruction or CMS policy. Per NCCI Chapter 8, if the code descriptor or CMS guidance indicates imaging is integral, you cannot separately report it. Confirm against current NCCI edits before billing fluoroscopy with 24134.

06How should bilateral cases be reported in an ASC versus HOPD setting?

In the HOPD setting, report a single line with modifier 50. In the ASC, report two separate claim lines, one with modifier LT and one with modifier RT, each with one unit of service — per CMS NCCI 2026 billing requirements.

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 sequestrum location (humeral shaft vs. distal humerus), the extent of necrotic bone removed, whether a soft-tissue abscess was debrided in the same field, intraoperative culture collection, and any staged procedure intent documented by the surgeon. This prevents the two most common audit flags: unbundled I&D billing and missing anatomic specificity that links the operative note to the correct ICD-10 chronic osteomyelitis code.

See how Mira captures CPT 24134 documentation