Reinsertion of a ruptured distal biceps or triceps tendon at the elbow, with or without tendon graft (graft harvest included when performed).
Verified May 8, 2026 · 7 sources ↓
- Medicare
- $716.12
- Total RVUs
- 21.44
- Global, days
- 90
- Region
- Elbow
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 7 cited references ↓
- Identify the specific tendon repaired (distal biceps or distal triceps) and confirm rupture versus partial tear
- Document the fixation technique by name (e.g., cortical button, suture anchor, transosseous tunnels) — 'standard repair' is an audit flag
- State whether a tendon graft was used and, if so, the graft source (autograft, allograft) and harvest site
- Record laterality (right vs. left elbow) explicitly in both the operative note and the postoperative diagnosis
- Note the surgical approach (single-incision vs. two-incision technique) and any neurovascular findings
- Capture pre-op imaging or clinical findings confirming complete rupture to support medical necessity
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 7 cited references ↓
CPT 24342 covers surgical reinsertion of a ruptured distal biceps or triceps tendon at the elbow. The code applies to both tendons distally and includes tendon graft harvest when a graft is used — you don't bill a separate graft-procurement code. Common techniques include single- or double-incision repair with suture anchors or cortical button fixation; document the specific technique and fixation method by name in the operative note.
The 90-day global period means all routine post-op care from the day of surgery through day 90 is bundled. Separate E/M visits within that window require modifier 24 (unrelated condition) or modifier 25 (separate significant evaluation on the same day as a procedure). A staged or unplanned return to the OR for the same tendon repair within the global carries modifier 78; an unrelated procedure in that window uses modifier 79.
Laterality modifiers (LT/RT) are required on every claim — payers routinely deny elbow surgery claims missing laterality. If a concomitant ulnar nerve transposition (64718) is performed, NCCI bundles it with adjacent elbow soft-tissue work; append modifier 59 or XS with documentation showing a distinct indication and separate operative effort.
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 | 8.74 |
| Malpractice RVU | 2.11 |
| Total RVU | 21.44 |
| Medicare national rate | $716.12 |
| 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 | $716.12 |
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 24342 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing laterality modifier — claims for elbow surgery without LT or RT are routinely rejected by commercial and Medicare payers
- Billing a separate tendon graft procurement code when graft harvest is already included in 24342
- Using 24342 when the operative note describes a partial repair or tendon debridement without true reinsertion — consider 24341 if reinsertion was not performed
- E/M visit billed within the 90-day global without modifier 24 or 25, triggering a global-period denial
- NCCI bundling denial when 64718 (ulnar nerve transposition) is billed same-day without modifier 59 or XS and supporting documentation
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 7 cited references ↓
01Does 24342 cover both distal biceps and distal triceps repairs?
02Is tendon graft harvest billed separately when using 24342?
03Can I bill a same-day E/M with 24342?
04How do I handle a same-day ulnar nerve transposition billed with 24342?
05What modifier applies if the patient returns to the OR within the global period for the same tendon?
06Is 24342 appropriate when the surgeon opened the arm but could not locate or retrieve the retracted tendon?
07What is the global period for 24342, and what does it include?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02aapc.comhttps://www.aapc.com/codes/cpt-codes/24342
- 03cms.govhttps://www.cms.gov/files/document/04-chapter4-ncci-medicare-policy-manual-2025finalcleanpdf.pdf
- 04cms.govhttps://www.cms.gov/files/document/05-chapter5-ncci-medicare-policy-manual-2026-final.pdf
- 05cgsmedicare.comhttps://www.cgsmedicare.com/medicare_dynamic/j15/partb/ptpb/ptp.aspx
- 06aapc.comhttps://www.aapc.com/codes/coding-newsletters/my-orthopedic-coding-alert/you-be-the-coder-pinpoint-triceps-repair-code-options-here-137233-article
- 07eatonhand.comhttps://www.eatonhand.com/coding/cpt27da.htm
Mira AI Scribe
Mira's AI scribe captures the tendon name (biceps vs. triceps), confirmation of complete distal rupture, fixation technique (e.g., cortical button, suture anchor), graft use and harvest site, surgical approach (single vs. two-incision), and laterality from dictation. That specificity prevents the two most common denials: wrong-code disputes when the op note is vague about reinsertion vs. repair, and laterality rejections when side isn't clearly documented.
See how Mira captures CPT 24342 documentation