Surgical lengthening of a single tendon in the upper arm or elbow region, reported once per tendon lengthened.

Verified May 8, 2026 · 4 sources ↓

Medicare: $540.76
Total RVUs: 16.19
Global, days: 90
Region: Elbow

Drawn from CMSAAPC

Documentation requirements

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

Source · Editorial brief grounded in 4 cited references ↓

Identify each tendon lengthened by anatomic name — generic references to 'elbow tendons' will not support per-tendon billing.
Document the indication: contracture etiology, degree of limitation, and failure of conservative management.
Specify surgical technique used for lengthening (e.g., Z-plasty, step-cut, fractional lengthening).
If ulnar nerve work was performed, document explicitly whether neuroplasty only or full transposition was done — this determines NCCI modifier eligibility.
Record preoperative and intraoperative range-of-motion measurements to substantiate medical necessity.
Note laterality (left or right arm) to support LT or RT modifier assignment.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 4 cited references ↓

CPT 24305 covers open surgical lengthening of an individual tendon at the upper arm or elbow — procedures commonly performed to address flexion contractures, spasticity, or post-traumatic tendon shortening. The code is reported per tendon; if two tendons are lengthened at the same operative session, bill 24305 twice with modifier 51 on the secondary unit. The 90-day global period includes all routine postoperative care through day 90.

A critical NCCI rule governs concurrent nerve work: ulnar nerve neuroplasty (64718) bundles into 24305 and is not separately reportable. However, ulnar nerve transposition at the elbow is a distinct service — if performed at the same session, append modifier 59 or XU to bypass the PTP edit. This distinction matters because the RVU weight of 64718 exceeds that of 24305, making unbundling decisions consequential.

Top billing specialties are hand surgery and orthopedic surgery. The procedure is performed in both HOPD and ASC settings; see the site-of-service comparison table for payment differentials between the two.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.43
Practice expense RVU	7.35
Malpractice RVU	1.41
Total RVU	16.19
Medicare national rate	$540.76
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	$540.76
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 24305 get rejected.

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

Bundling denial when 64718 is billed with 24305 without modifier 59 or XU — neuroplasty-only is not separately payable.
Insufficient documentation of medical necessity when conservative treatment history is absent from the record.
Missing per-tendon specificity in the operative note causes downcoding or denial of additional 24305 units.
Modifier 51 omitted on secondary tendon units billed same-day, triggering a duplicate-service edit.
Laterality modifier absent when payer policy requires LT or RT for unilateral upper-extremity procedures.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 4 cited references ↓

01Can I bill 24305 twice if two tendons were lengthened in the same session?

Yes. The code is defined per tendon. Bill 24305 for each tendon lengthened and append modifier 51 to the second and subsequent units. The operative note must name each tendon separately.

02Is ulnar nerve neuroplasty (64718) ever separately billable with 24305?

Neuroplasty alone is not — it bundles into 24305 under NCCI PTP edits with no bypass allowed for that component. Ulnar nerve transposition at the elbow is separately billable; append modifier 59 or XU to either code to bypass the edit when transposition was actually performed.

03What modifier do I use if I lengthen a tendon on the same day as an unrelated elbow procedure?

Modifier 59 or XS establishes a distinct procedural service when the tendon lengthening is truly separate from a concurrent procedure. If the second procedure is unrelated and occurs during a separate operative session within the global period, use modifier 79.

04Does the 90-day global period affect billing for a new problem treated at an office visit?

Yes. Any E/M service during the 90-day global for a reason unrelated to the tendon lengthening requires modifier 24. Without it, Medicare will bundle the visit into the global and deny it.

05Is laterality required for 24305?

CMS does not mandate laterality modifiers on this code nationally, but many commercial payers and some MACs require LT or RT for unilateral upper-extremity procedures. Check your payer contracts and MAC LCD policies before submitting without them.

06What ICD-10 diagnoses most commonly support medical necessity for 24305?

Acquired contractures of the elbow or upper arm (M24.52x), sequelae of upper-extremity trauma, and spastic conditions with tendon involvement are the most common supporting diagnoses. The specificity of the ICD-10 code needs to match the tendon and laterality documented in the operative report.

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 tendon name, lengthening technique, and degree of contracture correction from dictation, then flags whether any concurrent ulnar nerve work was neuroplasty-only versus transposition. That distinction determines whether modifier 59 or XU is required to bypass the NCCI PTP edit for 64718 — the most common audit trigger on this code.

See how Mira captures CPT 24305 documentation