Surgical removal of a previously implanted radial head prosthesis from the elbow joint.

Verified May 8, 2026 · 6 sources ↓

Medicare: $682.38
Total RVUs: 20.43
Global, days: 90
Region: Elbow

Drawn from CMSAAPCCgsmedicareEmedny

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 surgical approach (lateral, posterolateral, Kocher, etc.) — notes that say 'standard approach' flag on audit.
Specify the prosthesis removed: manufacturer, material (metal, pyrocarbon), and component type (monopolar, bipolar, stemmed).
Document the indication for removal — loosening, infection, instability, pain — with supporting clinical findings and imaging.
Record intraoperative findings including bone loss, soft-tissue condition, and any periprosthetic tissue sent for pathology or culture.
If an assistant surgeon is billed, the operative note must explicitly state medical necessity for the assistant and describe their role.
Confirm laterality (left or right elbow) in both the operative note and the diagnosis code to match claim modifiers LT or RT.

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 51 Multiple procedures 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 6 cited references ↓

CPT 24164 covers the open surgical removal of a radial head implant that was placed during a prior procedure. The radial head prosthesis — typically metal or pyrocarbon — sits at the proximal radius articulating with the capitellum and proximal ulna. Removal is indicated for implant failure, periprosthetic infection, aseptic loosening, instability, or pain refractory to conservative management. The surgeon accesses the lateral elbow, dissects through capsular and soft-tissue layers, and extracts the prosthetic component. If a new implant is placed at the same session, code separately for the reimplantation — 24164 covers removal only.

This is a 90-day global procedure. The global period covers the day-before visit, the surgery itself, and all routine post-op care through day 90. Unrelated E/M services during that window require modifier 24. A new and distinct surgical problem arising in the global period requires modifier 79. An unplanned return to the OR for a complication related to the original procedure uses modifier 78.

Site of service matters for this code. HOPD and ASC reimbursement differ substantially — see the Site of Service comparison table on this page. When billing an assistant surgeon, the operative note must document both medical necessity for the assistant and the specific role performed; modifier 80 or AS applies depending on who assisted.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.75
Practice expense RVU	8.6
Malpractice RVU	2.08
Total RVU	20.43
Medicare national rate	$682.38
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	$682.38
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 24164 get rejected.

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

Missing laterality modifier (LT or RT) — payers require this on unilateral elbow procedures.
Bundling denial when removal and reimplantation are billed without separating the distinct procedural work; verify NCCI edits before submitting companion codes.
Insufficient documentation of medical necessity for removal — payers deny when the record doesn't link clinical findings (imaging, prior failed treatment) to the decision to explant.
Assistant surgeon claim denied for lack of documented medical necessity and role in the operative report.
Global period conflict — post-op E/M billed without modifier 24 when the visit is genuinely unrelated to the elbow procedure.

Frequently asked questions

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

01Can I bill 24164 and a radial head reimplantation code on the same day?

Yes, if both removal and replacement are performed at the same session, bill each procedure separately. Check NCCI PTP edits for the specific code pair and apply modifier 51 or 59/XS as indicated. The operative note must document both the explant and the new implant as distinct, necessary steps.

02What modifier do I use if the patient returns to the OR within the 90-day global for a wound complication related to the original surgery?

Modifier 78 — unplanned return to the OR for a complication related to the original procedure. Do not use modifier 79 here; 79 is for unrelated procedures during the global period.

03Does the 90-day global period apply if the procedure is performed in an ASC?

Yes. The 90-day global still governs the physician's professional billing regardless of site. The facility bills separately; the global period restriction applies to the surgeon's professional component only.

04Is an assistant surgeon payable for 24164 under Medicare?

Check the CMS PFS assistant-at-surgery indicator for this code. When payable, use modifier 80 (MD assistant) or AS (PA, NP, or CNS assistant). The operative note must document why an assistant was medically necessary and what they specifically did — observation alone does not qualify.

05Which diagnosis codes best support medical necessity for 24164?

Lead with the specific complication driving removal: periprosthetic loosening (T84.038A/subsequent encounter), periprosthetic infection (T84.59XA), implant failure, or pain from the device. Pair with the underlying condition (e.g., sequelae of radial head fracture) as a secondary code. Payers deny when the primary ICD-10 is too vague or doesn't directly reference the implant.

06How does site of service affect reimbursement for 24164?

HOPD and ASC payments for the facility component differ significantly — see the Site of Service comparison table on this page. The physician's work RVU is the same regardless of site, but the practice expense RVUs are reduced when billing in a facility setting, so the professional fee is lower in HOPD or ASC than in a non-facility setting.

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 surgical approach by name, the specific prosthesis removed (manufacturer, material, component type), intraoperative findings, indication for removal, and laterality directly from dictation. This prevents the two most common audit flags on 24164: operative notes that omit approach detail and claims that lack a documented clinical rationale linking imaging or prior treatment failure to the explant decision.

See how Mira captures CPT 24164 documentation