Surgical removal of necrotic (dead) bone tissue — the sequestrum — from the radial head or neck at the elbow, typically performed to treat osteomyelitis or a bone abscess.

Verified May 8, 2026 · 6 sources ↓

Medicare: $600.55
Work RVU: 8.19
Global, days: 90
Region: Elbow

Drawn from CMSMdclarityBonesupportEmednyFastrvu

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 name the specific anatomic site — radial head vs. radial neck — not just 'proximal radius' or 'elbow'
Describe extent of necrotic bone removed, including approximate size or volume of sequestrum
Document the underlying diagnosis with specificity: organism (if known), chronicity (acute vs. chronic), and laterality for ICD-10 mapping
Record wound management at closure — primary closure, packing, or placement of antibiotic carrier — to support any add-on coding
Preoperative imaging (X-ray or MRI) in the chart confirming sequestrum location and confirming medical necessity
If modifier 22 is appended, the operative note must quantify why complexity significantly exceeded the typical procedure (e.g., extensive cortical involvement, prior failed surgery)

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 24136 covers sequestrectomy of the radial head or neck: the surgeon opens the affected area, identifies the devascularized bone fragment (sequestrum), and excises it to arrest infection spread and allow healthy tissue to repopulate the void. The procedure is anatomically specific to the proximal radius near the elbow joint — do not interchange with 24134 (shaft/distal humerus) or 24138 (olecranon process), which describe sequestrectomy at adjacent but distinct sites.

The 90-day global period means all routine post-op management through day 90 is bundled. If the patient requires re-debridement or irrigation for persistent infection during that window, modifier 78 applies for a return to the OR for a related procedure. A staged re-excision that was planned at the time of the index procedure should carry modifier 58.

Site of service matters here. HOPD and ASC reimbursement differ substantially from the Medicare Physician Fee Schedule facility rate — see the site-of-service comparison table. When osteomyelitis is the underlying diagnosis, ensure ICD-10 specificity (organism, chronicity, laterality) is documented in the operative note and the claim; vague infection coding is a common audit trigger for bone excision procedures.

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 (8.19) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.98) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.19
Practice expense RVU	8.05
Malpractice RVU	1.74
Total RVU	17.98
Medicare national rate	$600.55
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	$600.55
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 24136 get rejected.

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

Wrong site code selected — 24134 or 24138 billed when radial head/neck was the operative site
ICD-10 diagnosis code too vague (e.g., unspecified osteomyelitis without organism or laterality) fails medical necessity review
Missing preoperative imaging documentation to establish sequestrum presence and surgical indication
Global period conflict — post-op visit or re-debridement billed without modifier 78 or 79 during the 90-day window
Modifier 22 appended without supporting operative note language quantifying the increased complexity

Frequently asked questions

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

01How is 24136 different from 24134 and 24138?

All three are elbow-region sequestrectomies, but site is determinative: 24134 is shaft or distal humerus, 24136 is radial head or neck, and 24138 is the olecranon process. Billing the wrong code based on general 'elbow' documentation is a common audit flag — the operative note must name the specific bone and segment.

02What modifier applies if the patient returns for re-debridement of the same infection during the 90-day global?

Modifier 78 — unplanned return to the OR for a procedure related to the original surgery during the global period. If the re-debridement was planned and staged at the time of the index procedure, use modifier 58 instead.

03Can 24136 be billed bilaterally?

Bilateral radial head osteomyelitis is exceedingly rare, but if both sides are operated in the same session, append modifier 50 and document bilateral pathology explicitly. Most payers require the claim to reflect a single line with modifier 50; reimbursement typically caps at 150% of the single-procedure rate.

04Is prior authorization typically required for 24136?

Commercial payers commonly require prior authorization for elbow bone excision procedures, especially when osteomyelitis is the indication. Medicare does not require prior authorization, but MAC LCD policies on osteomyelitis treatment may impose documentation thresholds — check your local MAC before assuming coverage.

05Can antibiotic spacer or bone void filler placement be billed separately on the same day?

Potentially yes — bioabsorbable antibiotic carriers placed at the time of sequestrectomy may be separately reportable depending on the product and payer. Review NCCI edits for the specific add-on or supply code you intend to use. Payer policy varies significantly here; commercial plans often require separate medical necessity documentation for the filler.

06What ICD-10 codes support medical necessity for 24136?

Osteomyelitis codes (M86.x series) are the primary drivers — select for organism specificity, acuity (acute, subacute, chronic), and laterality (right vs. left radius). Bone abscess without frank osteomyelitis may map to M86.6x. Vague or unspecified codes increase denial risk on audit.

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 anatomic site (radial head vs. neck), extent of sequestrum excised, wound management method, and the confirmed diagnosis with organism and chronicity directly from dictation. That prevents the most common 24136 denial: a vague operative note that can't distinguish this code from 24134 or 24138, or that lacks the medical-necessity language required when osteomyelitis ICD-10 specificity is audited.

See how Mira captures CPT 24136 documentation