Radical resection of the elbow joint capsule, surrounding soft tissue, and heterotopic bone, performed with contracture release.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,090.21
Total RVUs: 32.64
Global, days: 90
Region: Elbow

Drawn from CMSAAPCMdclarityEatonhandAAOS

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 each component performed: capsular excision, heterotopic ossification removal, and specific contracture release technique
Document the extent of capsular excision — 'as much capsule as possible' or anterior vs. posterior capsulectomy, not just 'capsular release'
Identify any concurrent synovectomy with description of tissue removed and joints addressed
Specify which muscles or tendons were incised or lengthened for contracture release and the degree of motion gained intraoperatively
If ulnar nerve transposition was performed concurrently, document it as a distinct procedure with separate operative description to support separate billing
Preoperative imaging or prior treatment history supporting medical necessity for radical resection rather than arthroscopic or limited open approach

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 59 Distinct service 62 Co-surgeons 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 24149 covers radical resection of capsule, soft tissue, and heterotopic bone at the elbow, combined with contracture release. This is not a simple capsulotomy — the surgeon excises as much capsule as possible, clears heterotopic ossification, performs aggressive synovectomy if present, and releases musculotendinous structures causing the contracture. The operative note must reflect each component: capsular excision extent, HO removal, and the specific release performed.

The 90-day global period means all routine post-op visits, wound care, and elbow therapy coordination are bundled through day 90. Anything unrelated to the elbow contracture billed in that window needs modifier 24. A staged or unplanned return to the OR for a related elbow complication uses modifier 78; an unrelated elbow procedure in the global uses modifier 79.

Bundling is a common issue with this code. Simpler elbow procedures — arthrotomy with capsular release (24006), partial synovectomy (24101), or elbow arthroplasty codes — may be bundled with or superseded by 24149 depending on what was actually performed. Code to the most specific procedure that reflects the full scope of work. If the ulnar nerve was transposed at the same session, 64718 may be separately reportable with modifier 59 per NCCI guidance.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	15.81
Practice expense RVU	13.65
Malpractice RVU	3.18
Total RVU	32.64
Medicare national rate	$1,090.21
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	$1,090.21
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 24149 get rejected.

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

Operative note describes only capsulotomy or simple release — insufficient to support 'radical resection' level of work
Bundling with 24101 or 24006 when documentation doesn't clearly support the more extensive 24149 procedure
Missing medical necessity documentation: no imaging, prior conservative treatment, or functional limitation recorded
Global period conflicts — post-op services billed without modifier 24 when unrelated to elbow contracture
Bilateral billing without modifier 50 or separate line items with LT/RT when both elbows were addressed

Frequently asked questions

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

01What separates 24149 from 24006 or 24101?

24006 is an arthrotomy with capsular release. 24101 is a partial synovectomy. 24149 requires radical capsular excision combined with soft tissue and heterotopic bone resection and contracture release — a materially greater scope. If the note only documents a capsulotomy or limited synovectomy, 24149 won't hold up to audit.

02Can I bill 24006 or 24101 alongside 24149?

Generally no. Those procedures are components of the radical resection described by 24149. Billing them separately is unbundling. Code to the single most comprehensive procedure that reflects what was done.

03Is ulnar nerve transposition separately billable when done at the same session?

Yes. Per NCCI 2026 policy, ulnar nerve transposition at the elbow (64718) is separately reportable. Append modifier 59 to bypass any PTP edit. Simple decompression without transposition is not separately reportable.

04What global period applies and what does it cover?

24149 carries a 90-day global. That includes the day-before visit, the surgery, and all routine post-op elbow care through day 90. Unrelated visits in that window need modifier 24. A staged related procedure in the global uses modifier 58; an unplanned related return to the OR uses modifier 78.

05When does modifier 22 apply to 24149?

Use modifier 22 when the procedure required substantially more work than typical — for example, severe ankylosis, prior failed surgery with dense scarring, or extensive HO requiring significantly longer operative time. Attach a cover letter documenting the specific factors and operative time.

06Can 24149 be billed bilaterally?

Yes, though bilateral elbow contracture release is rare. Append modifier 50 for bilateral billing on a single line, or use LT and RT on separate lines per payer preference. Verify individual payer rules — some commercial payers require separate line items.

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 operative narrative components critical for 24149: extent of capsular excision, description of heterotopic ossification removed, synovectomy findings, specific musculotendinous structures released, and intraoperative range of motion gained post-release. It also flags concurrent ulnar nerve transposition for potential separate coding under 64718. This prevents downcoding to 24006 or 24101 when the documentation doesn't explicitly reflect the radical resection scope of work.

See how Mira captures CPT 24149 documentation