Radical resection of a tumor involving the radial head or neck at the elbow, requiring wide surgical excision of bone and surrounding tissue.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $1,224.14
- Total RVUs
- 36.65
- Global, days
- 90
- Region
- Elbow
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 5 cited references ↓
- Preoperative imaging (MRI or CT) confirming tumor location at radial head or neck
- Pathology or biopsy report establishing tumor diagnosis prior to or at time of resection
- Operative note specifying extent of bone resected (radial head, neck, or both) and soft tissue margins taken
- Intraoperative or postoperative pathology specimen submission documentation confirming radical resection intent
- Reconstruction plan or note if prosthetic replacement or soft tissue repair was performed in the same session
- Medical necessity statement linking the diagnosis (ICD-10) to the radical — not simple — nature of the resection
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 5 cited references ↓
CPT 24152 covers radical resection of a tumor at the radial head or neck — a procedure that goes well beyond simple excision. The surgeon removes the involved bone segment along with a wide margin of surrounding soft tissue to achieve oncologic clearance. This is distinct from a standard radial head excision (24145) performed for arthritic or traumatic indications; the tumor context drives the radical nature of the dissection and the documentation burden.
The 90-day global period means all routine elbow follow-up visits, wound checks, and related post-op management through day 90 are included in the surgical fee. If a separately identifiable condition requires an E/M visit during that window, bill it with modifier 24. An unplanned return to the OR for a related complication falls under modifier 78; an unrelated procedure in the global period gets modifier 79.
Site of service matters significantly here: HOPD and ASC payments differ materially (see the Site of Service comparison table). Most radical tumor resections of this magnitude occur in a hospital or HOPD setting given the potential need for intraoperative pathology, vascular access, and reconstruction. If reconstruction or prosthetic replacement follows the resection in the same session, evaluate whether additional codes are separately reportable or bundled under NCCI edits before appending modifiers.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 19.49 |
| Practice expense RVU | 13.01 |
| Malpractice RVU | 4.15 |
| Total RVU | 36.65 |
| Medicare national rate | $1,224.14 |
| 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 | $1,224.14 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $4,948.07 |
Common denial reasons
The recurring reasons claims for CPT 24152 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Operative note describes a standard radial head excision rather than oncologic radical resection with margins
- Missing or absent pathology/biopsy documentation to support a tumor diagnosis and justify the radical approach
- Unbundling denial when reconstruction or arthroplasty performed same session is billed without verifying NCCI edits
- Global period violation — routine post-op elbow visits billed without modifier 24 during the 90-day window
- ICD-10 diagnosis code does not support malignant or aggressive tumor requiring radical resection
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01How does 24152 differ from 24145 (radial head or neck excision)?
02What ICD-10 codes support medical necessity for 24152?
03Can 24152 and a same-session elbow arthroplasty be billed together?
04Does the 90-day global include the oncologic follow-up visits?
05Is modifier 22 ever appropriate for 24152?
06Which site of service — HOPD or ASC — is typical for 24152?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02emedny.orghttps://www.emedny.org/providermanuals/physician/pdfs/physician%20procedure%20codes%20sect5.pdf
- 03cms.govhttps://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-faq-library
- 04cgsmedicare.comhttps://www.cgsmedicare.com/medicare_dynamic/j15/partb/ptpb/ptp.aspx
- 05mdclarity.comhttps://www.mdclarity.com/cpt-code/24153
Mira AI Scribe
Mira's AI scribe captures the tumor location (radial head vs. neck), extent of bony resection, soft tissue margin description, specimen submission details, and any same-session reconstruction from dictation. This prevents the single most common denial for 24152: an operative note that reads like a standard radial head excision rather than an oncologic radical resection — a distinction auditors and payers scrutinize closely.
See how Mira captures CPT 24152 documentation