Open repair of the lateral collateral ligament of the elbow using local tissue — no graft harvest required.

Verified May 8, 2026 · 6 sources ↓

Medicare: $676.70
Total RVUs: 20.26
Global, days: 90
Region: Elbow

Drawn from AAPCKzanowAAOSEatonhandCMS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify 'lateral collateral ligament' by name — operative notes that say 'collateral ligament repair' without laterality are insufficiently specific and invite upcoding audits
Confirm local tissue technique: document that no graft was harvested; if graft was used, 24343 is the wrong code
State the laterality of the elbow operated (left or right) to support LT/RT modifier use
Document the mechanism of injury or clinical indication (dislocation, instability, trauma) and pre-op imaging findings confirming LCL tear or laxity
If billing 24343 alongside a fracture code, document distinctly why the ligament repair was not part of the surgical approach and required separate, additional work
Record intraoperative findings describing the extent of ligament damage to support modifier 22 if work was substantially greater than typical

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 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 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 6 cited references ↓

CPT 24343 covers open surgical repair of a torn or lax lateral collateral ligament (LCL) of the elbow using tissue already at the operative site. No tendon graft is harvested. When a graft is harvested and used for reconstruction instead of primary repair, report 24344. The distinction between repair (24343) and reconstruction (24344) is not cosmetic — payers will downcode or deny 24343 if the operative note describes graft harvest.

This code carries a 90-day global period. Routine post-op visits, wound checks, and splint/cast changes through day 90 are included. Bill modifier 24 on any E/M visit during the global that addresses an unrelated problem; use modifier 57 on the decision-for-surgery E/M if that visit occurred the day of or day before surgery.

Bundling is a real risk here. Per AAOS Global Service Data, 24343 is included within CPT 24666 (open treatment of radial head/neck fracture with radial head prosthetic replacement). The rationale: incising the LCL complex is part of the surgical approach for radial head replacement, so ligament repair is not separately payable even if the ligament was torn by the injury. Attempting to bill both on the same date without payer-specific documentation supporting distinct work will result in denial of 24343.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.93
Practice expense RVU	9.55
Malpractice RVU	1.78
Total RVU	20.26
Medicare national rate	$676.70
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	$676.70
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI G2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 24343 get rejected.

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

Bundled into CPT 24666 (radial head prosthetic replacement) when both codes are billed same-day — AAOS GSD flags 24343 as included
Operative note describes graft harvest, causing payer to remap to 24344 or deny 24343 as miscoded
Missing or ambiguous laterality in documentation when LT/RT modifier is applied — claim rejected for modifier-documentation mismatch
Billed during the 90-day global period of a prior elbow procedure without the appropriate modifier 79 (unrelated) or 78 (related return to OR)
Diagnosis code does not support lateral ligament pathology — medial-side ICD-10 codes linked to a lateral repair trigger medical necessity denials

Frequently asked questions

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

01What is the difference between CPT 24343 and CPT 24344?

24343 uses local tissue already at the operative site — no graft harvest. 24344 covers reconstruction with a tendon graft, including harvesting that graft. If the surgeon took a graft from anywhere, 24343 is the wrong code.

02Can I bill 24343 with CPT 24666 on the same date?

No. AAOS Global Service Data includes 24343 within 24666. The LCL complex is incised as part of the surgical approach for radial head prosthetic replacement, so its repair — even if the ligament was traumatically torn — is not separately payable.

03Do I need a modifier for bilateral elbow LCL repair?

Yes. Bilateral repair on the same date requires modifier 50, or separate line items with LT and RT. Bilateral traumatic LCL tears are rare, so expect payer scrutiny — have imaging and operative notes ready.

04What modifier applies if this is billed during an existing elbow global period?

Modifier 79 if the LCL repair is unrelated to the original procedure. Modifier 78 if the patient returned to the OR for a related complication. Do not invert these — using 78 for an unrelated procedure is a known audit trigger.

05When is modifier 22 appropriate for CPT 24343?

When the surgical work was substantially greater than typical — for example, a severely scarred field from prior surgery, a complex chronic dislocation, or an unusually extensive tear requiring significantly longer operative time. Documentation must quantify the additional time and describe the specific factors that increased complexity.

06Which ICD-10 codes are appropriate to link with 24343?

Sprains and tears of the lateral collateral ligament of the elbow are the primary diagnoses. If the surgeon documented elbow instability or dislocation, use the code that matches documented pathology. Linking a medial-side diagnosis code to a lateral repair is a medical necessity denial waiting to happen.

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 ligament side (lateral vs. medial), tissue technique (local vs. graft), operative approach, intraoperative stability findings, and whether additional fracture or dislocation work was performed in the same session. That detail prevents the two most common 24343 denials: miscoding to 24344 when no graft was used, and bundling into 24666 when the ligament repair was a distinct procedure rather than part of the approach.

See how Mira captures CPT 24343 documentation