Surgical · Elbow

Partial excision of the olecranon process of the ulna at the elbow, removing a portion of that bony prominence

Verified May 8, 2026 · 4 sources ↓

Medicare: $596.54
Total RVUs: 17.86
Global, days: 90
Region: Elbow

Drawn from CMSNovitasEmedny

Documentation requirements

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

Source · Editorial brief grounded in 4 cited references ↓

Specify the extent of bone removed — 'partial' is insufficient; document the estimated volume or linear dimension of olecranon resected
Identify the underlying pathology driving resection (e.g., olecranon spur, heterotopic ossification, nonunion fragment, osteophyte)
Confirm preservation or repair status of triceps tendon insertion in the operative note
Document pre-op imaging (X-ray or CT) correlating to the intraoperative findings and confirming bony pathology
Record the surgical approach and any concomitant soft-tissue procedures performed at the same site
Indicate laterality (left or right elbow) in both the operative note and on the claim

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 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 4 cited references ↓

CPT 24147 covers surgical partial removal of the olecranon process — the bony tip of the elbow — when pathology such as olecranon bursitis with ossification, heterotopic bone formation, osteophytes, or stress fracture nonunion requires debulking rather than complete resection. The surgeon removes the diseased or excess portion of the olecranon while preserving the triceps attachment and articular integrity. This is distinct from complete olecranon excision and from soft-tissue bursectomy alone (which does not include bone work).

The 90-day global period means all routine post-op elbow care through day 90 — wound checks, splint/cast changes, suture removal — is bundled. Any unrelated procedure in that window needs modifier 79. A return to the OR for a related complication (e.g., wound dehiscence requiring irrigation and debridement) bills under modifier 78. If a separately identifiable E/M is performed on the same day as the decision for surgery, append modifier 57 to the E/M.

Site of service matters here: the HOPD payment is substantially higher than the ASC rate (see the Site of Service comparison table). When the procedure can be safely performed in an ASC, payers scrutinize facility selection. Document medical necessity for the chosen setting if billing at the HOPD rate.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.64
Practice expense RVU	8.69
Malpractice RVU	1.53
Total RVU	17.86
Medicare national rate	$596.54
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	$596.54
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 24147 get rejected.

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

Billed as complete olecranon excision when only partial resection was performed — code mismatch triggers downcoding or denial
Missing pre-operative imaging documentation to support medical necessity of bony resection
Soft-tissue bursectomy alone performed but 24147 billed — bone work must be documented to support this code
Modifier LT or RT omitted, triggering laterality edits at many payers
Unbundled concomitant procedures that are included in the global without adequate documentation of distinct, separately reportable work

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 4 cited references ↓

01What is the difference between CPT 24147 and a simple olecranon bursectomy?

A bursectomy removes only the bursa sac — no bone is touched. CPT 24147 requires actual partial resection of the olecranon process itself. If your operative note only describes bursa excision, 24147 will not hold up to audit. The bone work must be explicitly documented.

02Can I bill 24147 with an elbow arthroscopy on the same day?

Only if the partial olecranon excision is performed through an open approach distinct from the arthroscopic work, or if the arthroscopic procedure does not already include olecranon debridement. Check NCCI PTP edits for the specific arthroscopy code pairing. If separate, append modifier 59 or XS with documentation of distinct service.

03Does the 90-day global include physical therapy referrals?

No. PT services billed by a separate therapist or therapy practice are not bundled into the surgeon's global. Only the surgeon's own post-op visits and directly related management are included. The therapy practice bills independently.

04When should I use modifier 22 on 24147?

Modifier 22 is appropriate when the procedure is substantially more work than typical — for example, dense heterotopic ossification requiring extended operative time, or prior hardware complicating resection. Attach a cover letter with the operative note quantifying the increased time and difficulty. Without that documentation, payers routinely ignore modifier 22 and pay at the base rate.

05How does site of service affect reimbursement for 24147?

The HOPD rate is roughly double the ASC rate under the 2026 CMS fee schedule. Some payers apply site-of-service differentials and will scrutinize HOPD billing for procedures routinely performed in ASCs. Document medical necessity for HOPD if the patient's comorbidities or anticipated complexity require that setting.

06Is a staged revision of olecranon resection in the global period billable?

A planned staged procedure billed within the 90-day global needs modifier 58. An unplanned return for a related complication uses modifier 78. Using the wrong modifier is a common audit finding — modifier 78 reimburses at a reduced rate and does not start a new global; modifier 58 does start a new global period.

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 surgeon's dictation for 24147 by flagging the specific description of bone volume resected, triceps status, and the named pathology (spur, HO, osteophyte, nonunion fragment). It also extracts laterality from dictation automatically. This prevents the most common audit flag — an operative note that documents bursectomy without explicit mention of bone work — which causes payers to downcode to a soft-tissue excision code and deny the higher-value procedure.

See how Mira captures CPT 24147 documentation