Surgical tendon repair with muscle transfer to restore elbow flexion, specifically transferring the pectoralis major to the biceps tendon to compensate for biceps paralysis.

Verified May 8, 2026 · 5 sources ↓

Medicare: $729.48
Total RVUs: 21.84
Global, days: 90
Region: Elbow

Drawn from CMSAAPCFastrvuSgo

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Operative note must name the specific muscle transferred (pectoralis major to biceps tendon) — 'tendon transfer' alone is insufficient for audit defense.
Document the diagnosis driving the procedure, including the etiology of biceps paralysis (traumatic, neurologic, post-surgical, etc.).
Pre-operative functional assessment documenting loss of active elbow flexion and failed conservative management.
Intraoperative findings including tendon quality, extent of repair, and confirmation of successful muscle transfer fixation.
Laterality (left vs. right arm) must be explicit in both the operative report and on the claim.

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 25 Significant separate E/M 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 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 5 cited references ↓

CPT 24320 covers a tenoplasty of the elbow-to-shoulder region that includes both tendon repair and muscle transfer. The defining element is transfer of the pectoralis major muscle to the biceps tendon to restore active elbow flexion lost due to biceps paralysis — a constellation of work that distinguishes this code from simpler tendon repairs in the same anatomic zone.

This is a 90-day global procedure. Every routine post-op visit, wound check, and dressing change through day 90 is bundled into the payment. Unrelated E/M services during that window require modifier 24. A significant, separately identifiable E/M on the day of surgery requires modifier 25.

Site of service matters here. The HOPD and ASC facility payments differ substantially — see the Site of Service comparison table on this page. Perform this in an ASC when clinically feasible and document the decision; payers increasingly audit high-facility-cost cases billed in HOPD settings when ASC is appropriate.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.59
Practice expense RVU	9
Malpractice RVU	2.25
Total RVU	21.84
Medicare national rate	$729.48
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	$729.48
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 24320 get rejected.

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

Missing or vague diagnosis: payers deny when the ICD-10 code doesn't clearly support biceps paralysis or tendon pathology requiring transfer-level reconstruction.
Bundling conflicts with same-day tendon or soft-tissue codes — verify NCCI edits before billing 24320 alongside other elbow repair codes.
Lack of medical necessity documentation: no pre-op functional deficit or failed conservative care noted in the record.
Laterality missing on claim — modifier LT or RT absent triggers edit-based denial on many payer systems.
Global period violations: post-op E/M visits billed without modifier 24 when the visit is unrelated to the surgical episode.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What makes 24320 different from other elbow tendon repair codes?

24320 specifically includes a muscle transfer — pectoralis major to biceps tendon — to restore elbow flexion. Codes for simple tendon repair or tenodesis without a muscle transfer don't capture that work and will underpay the procedure.

02Do I need modifier LT or RT on every claim for 24320?

Yes. Laterality is required. Most payers and CMS-aligned edits will flag or deny claims without LT or RT on unilateral upper-extremity surgical codes.

03Can 24320 be billed with an E/M on the same day?

Only if the E/M is a significant, separately identifiable service beyond standard pre-op assessment. Append modifier 25 to the E/M and document the distinct decision-making in the office note.

04What is the global period for 24320, and what does it include?

90-day global. Bundled into payment: the day-before pre-op visit, the surgery itself, and all routine follow-up care through day 90. Bill unrelated post-op E/M with modifier 24 and a distinct ICD-10 code.

05When should modifier 22 be appended to 24320?

When the procedure required substantially greater work than typical — for example, severe scarring from prior surgery, a revision scenario, or unusual anatomic complexity. The operative note must include a concise statement explaining why the work exceeded standard, and supporting documentation should be attached on submission.

06Is 24320 payable in an ASC setting?

Yes, and the ASC facility payment is substantially lower than HOPD — see the Site of Service comparison table. Perform this in an ASC when clinically appropriate; payers may scrutinize HOPD billing for cases where ASC is a viable alternative.

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 transferred muscle (pectoralis major), the recipient tendon (biceps), the operative approach, laterality, and the documented pre-op functional deficit from the surgeon's dictation. This prevents the most common denial trigger for 24320: a vague operative note that fails to distinguish a full muscle-transfer tenoplasty from a simple tendon repair, which auditors use to downcode or deny the claim entirely.

See how Mira captures CPT 24320 documentation