Surgical advancement of the flexor muscle origin at the elbow, relocating the flexor-pronator group proximally on the humerus to restore or improve elbow flexion strength.

Verified May 8, 2026 · 7 sources ↓

Medicare: $677.04
Total RVUs: 20.27
Global, days: 90
Region: Elbow

Drawn from CMSFastrvuAAPCMdclarityEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Preoperative diagnosis specifying the cause of flexion weakness (e.g., brachial plexus injury, post-polio, neuromuscular condition) with supporting clinical findings or nerve studies
Operative note naming the specific technique (Steindler advancement or equivalent) and documenting the proximal level of reattachment on the humeral shaft
Documentation of failed or exhausted conservative measures, including physical therapy trials, prior to surgical intervention
Neurovascular status of the extremity recorded both pre- and intraoperatively, including any medial nerve or ulnar nerve findings
If modifier 22 is appended, the operative note must quantify the added complexity — time, encountered scarring, prior surgical changes, or anatomic distortion — not just state 'difficult case'
Postoperative immobilization plan and anticipated rehabilitation protocol to support medical necessity and global period management

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 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 7 cited references ↓

CPT 24330 describes a flexorplasty of the elbow — most commonly the Steindler-type advancement — in which the surgeon detaches the common flexor-pronator origin from the medial epicondyle and reattaches it several centimeters proximally on the humeral shaft. Moving the origin up the bone increases the mechanical advantage of the flexors, restoring useful elbow flexion in patients with significant weakness or paralysis.

This procedure is typically indicated after brachial plexus injuries, poliomyelitis sequelae, or other conditions that have left the patient with inadequate active elbow flexion despite an intact distal extremity. The 90-day global period means all routine follow-up — wound checks, splint or cast management, and therapy coordination visits — are bundled through day 90. Any separately identifiable new problem or unrelated procedure in that window requires modifier 24 or 79, respectively.

Site of service matters for 24330. HOPD and ASC facility payments differ substantially (see the Site of Service comparison table). The work is assigned a 90-day global, and because the procedure is rarely bilateral, modifier 50 applies only when both elbows are explicitly addressed in the operative note. Modifier 22 is defensible when documented intraoperative complexity — severe scarring, prior hardware, anatomic distortion — added measurable time and effort beyond the typical case.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.55
Practice expense RVU	8.68
Malpractice RVU	2.04
Total RVU	20.27
Medicare national rate	$677.04
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	$677.04
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 24330 get rejected.

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

Medical necessity not established — missing preoperative documentation of functional flexion deficit, failed conservative care, or underlying diagnosis driving the surgery
Operative note uses generic language ('standard approach,' 'routine advancement') without naming the technique or specifying the level of proximal reattachment
Modifier 22 submitted without supporting documentation quantifying the increased work, resulting in automatic downcoding or denial of the enhanced payment request
Bilateral claim submitted without clear operative documentation that both elbows were addressed in the same session
Unrelated procedure billed in the 90-day global period without modifier 79, triggering a bundling denial

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What is the global period for CPT 24330?

CPT 24330 carries a 90-day global period. The day of surgery plus the next 90 days are bundled — routine post-op visits, wound checks, splint management, and stitch removal are all included. Separate billing in that window requires modifier 24 for unrelated E/M visits or modifier 79 for unrelated procedures.

02When is modifier 22 appropriate for 24330?

Append modifier 22 when the operative note documents specific factors that materially increased work — dense scar from prior surgery, severe muscle fibrosis, or prolonged operative time. The note must quantify the added effort. Submitting modifier 22 without that documentation results in denial or automatic reversion to the base payment.

03Can 24330 be billed bilaterally?

Yes, but only if both elbows were operated on in the same session and the operative note documents both sides explicitly. Append modifier 50 to a single line, or bill LT and RT on separate lines per payer preference. Bilateral flexorplasty is uncommon — expect payer scrutiny and ensure the clinical record supports the indication on each side.

04What ICD-10 diagnoses are most commonly paired with 24330?

Brachial plexus injury sequelae, post-poliomyelitis syndrome, and other paralytic conditions affecting elbow flexion are the primary drivers. The diagnosis code must reflect the underlying condition causing the functional deficit, not just elbow pain. Mismatch between the surgical indication and the ICD-10 code is a frequent cause of medical necessity denial.

05Is 24330 subject to any notable NCCI bundling edits?

Procedures on adjacent structures — such as ulnar nerve transposition (64718) — may be separately reportable with modifier 59 or XU if a distinct operative indication exists, consistent with CMS NCCI Chapter 4 guidance on elbow procedures. Standard wound closure and routine nerve retraction are included in the global package and cannot be billed separately.

06Does site of service affect reimbursement for 24330?

Yes, significantly. HOPD and ASC facility payments differ — see the Site of Service comparison table on this page. The physician's professional fee also shifts between facility and non-facility RVU values depending on where the case is performed. Confirm your payer's site-of-service policy before scheduling.

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 flexorplasty technique by name (Steindler advancement or equivalent), the level of proximal reattachment on the humerus, and the intraoperative neurovascular findings from dictation. It flags operative notes that describe the technique in generic terms — audit teams reject notes that don't specify the advancement distance or reattachment site, and vague language is the leading reason modifier 22 claims for 24330 are denied on appeal.

See how Mira captures CPT 24330 documentation