Surgical removal of a foreign body lodged in the subcutaneous tissue of the upper arm or elbow area.

Verified May 8, 2026 · 6 sources ↓

Medicare: $243.16
Total RVUs: 7.28
Global, days: 10
Region: Elbow

Drawn from CMSAAOSMdclarityEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the exact anatomic location: upper arm versus elbow, and laterality (left or right).
Describe the foreign body: material type, estimated size, and how it was identified (clinical exam, plain film, ultrasound).
Document tissue depth confirming subcutaneous — not subfascial or intramuscular — to distinguish 24200 from 24201.
Operative note must include the technique used to localize and extract the object, not just 'foreign body removed'.
Record wound closure method and any intraoperative imaging used for localization.
If modifier 22 is appended, document the specific factors (extensive scarring, difficult localization, prolonged operative time) that made the work substantially greater than typical.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 25 Significant separate E/M 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 24200 covers the open surgical extraction of a foreign object — glass, metal, wood, needle fragments, or similar material — embedded in the subcutaneous layer of the upper arm or elbow region. The procedure requires incision, localization of the object (often with intraoperative imaging or probing), and closure. It is distinct from deeper removal: if the foreign body is below the fascia or within muscle, 24201 applies instead.

The 10-day global period means routine follow-up through postop day 10 is bundled. An E/M on the same day as the procedure is separately billable only if it is a significant, separately identifiable service — append modifier 25 to the E/M code. If the clinical encounter that led to the decision to operate was the day before or day of the procedure and the procedure carries a 90-day global, modifier 57 would apply — but with a 010 global, modifier 57 is not used here.

Site-of-service payment differential is marked: HOPD reimbursement vastly exceeds the ASC rate, so confirming the correct place-of-service code on the claim is essential. Laterality modifiers (LT/RT) are expected when the operative site is a single limb. Bilateral procedures on both upper extremities in the same session warrant modifier 50.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	1.76
Practice expense RVU	5.16
Malpractice RVU	0.36
Total RVU	7.28
Medicare national rate	$243.16
Global period	10 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	$243.16
HOPD (APC 5072) Hospital outpatient department	$1,687.37
ASC (PI P3) Ambulatory surgical center (freestanding)	$173.21

Common denial reasons

The recurring reasons claims for CPT 24200 get rejected.

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

Missing laterality: submitting without LT or RT when payer requires it triggers automatic rejection.
Depth not documented: payers deny or downcode when the operative note does not clearly state subcutaneous tissue, leaving the distinction from 24201 unsupported.
E/M billed same day without modifier 25, causing the visit to bundle into the surgical package.
Place-of-service mismatch between the claim and the actual facility type, triggering payment at the incorrect site-of-service rate.
ICD-10 diagnosis code does not specify a retained or embedded foreign body — using a superficial injury code instead of the appropriate foreign body retained/embedded code causes medical necessity denial.

Frequently asked questions

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

01What is the difference between 24200 and 24201?

Depth is the only distinction. 24200 is for foreign bodies in the subcutaneous tissue above the fascia. 24201 applies when the object is deep to the fascia — in muscle or deeper structures. The operative note must state the tissue plane clearly; vague documentation defaults to the lower-valued code on audit.

02Do I need LT or RT on every 24200 claim?

Most payers require a laterality modifier on single-limb procedures. Submitting 24200 without LT or RT is a common clean-claim failure. If truly bilateral in the same session, use modifier 50 instead.

03Can I bill an E/M on the same day as 24200?

Yes, if the E/M represents a significant, separately identifiable service beyond the standard pre- and post-procedure assessment. Append modifier 25 to the E/M code. Without modifier 25, the visit bundles into the 10-day global and will not be separately reimbursed.

04The patient had two separate foreign bodies removed from the same arm in the same session. How do I bill that?

Bill 24200 once. Multiple foreign bodies removed from the same anatomic region in the same operative session are reported with a single unit. If the work was substantially greater than typical due to multiple objects, document that clearly and consider modifier 22 — but a second unit of 24200 will not survive NCCI review.

05The patient returns during the 10-day global because the foreign body was incompletely removed. How do I bill the return procedure?

An unplanned return to the procedure room for a related issue during the global period uses modifier 78 on the repeat procedure code. If the return is for a completely unrelated surgical problem, use modifier 79. Do not invert these — modifier 78 is for related procedures, 79 is for unrelated ones.

06Why is the ASC payment for 24200 so much lower than the HOPD rate?

CMS sets HOPD and ASC payment rates under separate prospective payment systems with different APC and wage-index calculations. The gap for 24200 is significant — see the Site of Service comparison table on this page. Verify your place-of-service code (11, 22, 24) matches where the procedure actually occurred; a mismatch results in payment at the wrong rate.

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 foreign body material, anatomic location (upper arm versus elbow), confirmed tissue depth (subcutaneous), laterality, and localization method from the surgeon's dictation. That structured output prevents the two most common denials for 24200: missing laterality and an operative note that fails to confirm subcutaneous depth — the single detail that separates this code from 24201.

See how Mira captures CPT 24200 documentation