Injection · Elbow

Injection of contrast material into the elbow joint cavity in preparation for arthrographic imaging.

Verified May 8, 2026 · 6 sources ↓

Medicare: $186.38
Total RVUs: 5.58
Global, days: 0
Region: Elbow

Drawn from CMSAAPCEmednyMdclarityNIH

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify laterality — document which elbow (right, left, or bilateral) received the injection
Document the clinical indication requiring arthrographic evaluation (e.g., suspected ligament tear, cartilage damage, unexplained joint pain)
Identify the contrast agent used and the injection technique, including needle placement approach
Record imaging modality ordered post-injection (plain film arthrogram, CT arthrogram, or MRI arthrogram)
Note any image guidance used for needle placement (fluoroscopy, CT) — required to support a separately billed guidance code
Document patient consent and any relevant pre-procedure allergy screening for contrast material

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

26 Professional component 50 Bilateral procedure 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 24220 covers the injection procedure component of elbow arthrography — introducing contrast agent into the joint space so that structures like cartilage, ligaments, and the joint capsule are visible on subsequent imaging (plain film, CT arthrogram, or MRI arthrogram). The code covers the injection only. Radiologic supervision and interpretation, as well as the imaging itself, are coded separately.

The global period is 000, meaning no pre- or post-operative visits are bundled. Fluoroscopic or CT guidance used to place the needle accurately is billed separately under the appropriate radiology guidance code. When the professional and technical components are split between providers or facilities, modifier 26 applies to the interpreting physician's claim.

Laterality matters: append LT or RT to identify which elbow. If both elbows are injected in the same session, modifier 50 applies on a single claim line for Medicare; split into LT and RT lines for ASC claims 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	1.28
Practice expense RVU	4.17
Malpractice RVU	0.13
Total RVU	5.58
Medicare national rate	$186.38
Global period	0 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	$186.38

Common denial reasons

The recurring reasons claims for CPT 24220 get rejected.

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

Missing laterality modifier (LT or RT) — many payers auto-deny elbow codes without a side designation
Bundling of the injection with the imaging study when radiology and injection are billed by separate providers without appropriate modifier 26 on the professional component
Billing fluoroscopic or CT guidance without a separate radiology guidance code or without documentation confirming image guidance was actually performed
Lack of documented medical necessity — vague indications such as 'elbow pain' without specificity as to why arthrography is required over standard imaging

Frequently asked questions

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

01Does 24220 include the arthrogram images themselves?

No. 24220 covers the injection procedure only. The radiologic supervision and interpretation and the actual imaging study are billed separately under the appropriate radiology codes.

02Do I need a laterality modifier on 24220?

Yes. Append LT or RT on every claim. For bilateral same-session injections, Medicare requires modifier 50 on a single claim line; ASC claims should use separate LT and RT lines per NCCI billing rules.

03Can I separately bill fluoroscopic guidance used to place the needle?

Yes, image guidance is not bundled into 24220. Bill the appropriate fluoroscopic or CT guidance code separately and document in the operative/procedure note that guidance was used and why.

04What is the global period for 24220?

The global period is 000 — zero post-operative days. There are no bundled pre- or post-procedure visits, so E/M services on the same date can be billed with modifier 25 if separately documented and medically necessary.

05Is 24220 appropriate for both CT arthrogram and MRI arthrogram preparation?

Yes. The injection procedure is the same regardless of whether the subsequent imaging is a CT arthrogram or MRI arthrogram. The distinction in imaging modality affects only the separately billed imaging codes, not 24220.

06When would modifier 78 apply to 24220?

Modifier 78 applies if the patient returns to the procedure room during the postoperative period of a related prior procedure and requires an unplanned repeat injection — for example, if initial contrast placement failed to opacify the joint adequately. Do not use 78 for an unrelated elbow injection; that is modifier 79.

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 contrast agent injected, needle approach, confirmed intra-articular placement, laterality, and the imaging modality ordered post-injection — all from dictation. This prevents the two most common 24220 denials: missing laterality and a missing link between the injection note and the arthrogram order that justifies medical necessity.

See how Mira captures CPT 24220 documentation