Open repair of the elbow's medial collateral ligament using local tissue harvested from the operative site

Verified May 8, 2026 · 6 sources ↓

Medicare: $674.70
Total RVUs: 20.2
Global, days: 90
Region: Elbow

Drawn from CMSAAPCMdclarityAoassn

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify that local tissue — not a tendon graft — was used for the repair, directly distinguishing 24345 from 24346
Document the indication: valgus instability grade, throwing-related symptoms, or post-traumatic MCL disruption with supporting physical exam findings
Name the surgical approach (e.g., medial approach with flexor-pronator split or elevation) — notes that say 'standard approach' are an audit flag
Confirm tissue quality and repair technique (primary suture anchors, imbrication, etc.) with intraoperative findings noted
If additional procedures were performed at the same session, document each procedure's distinct purpose to support separate billing and any modifier applied
Record pre-op imaging (MRI or stress radiographs) confirming MCL pathology to support medical necessity

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 50 Bilateral procedure 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 6 cited references ↓

CPT 24345 covers open surgical repair of the elbow medial collateral ligament (MCL) using tissue available at the operative field — no tendon autograft or allograft is harvested from a separate site. This distinguishes it from 24346, which involves a free tendon graft. The classic indication is MCL insufficiency causing valgus instability, most often in overhead-throwing athletes, but also after trauma or dislocation.

The 90-day global period covers the day-before visit, the procedure itself, and all routine post-op management through day 90. Any unrelated E/M or procedure during that window requires modifier 24 or 79, respectively. Modifier 78 applies if the patient returns to the OR for a complication directly related to the MCL repair.

Be alert to NCCI bundling: per CMS Hospital PTP Edits effective January 1, 2026, 24345 appears as a column two code in edit pairs with other elbow reconstruction codes. When MCL repair is performed as part of an open elbow dislocation reduction (24615), the ligament work is typically considered included — bill 24615, not 24345 separately, unless the operative note clearly supports distinct, separately reportable work.

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	9.45
Malpractice RVU	1.82
Total RVU	20.2
Medicare national rate	$674.70
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	$674.70
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 24345 get rejected.

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

Upcoding challenge: payer disputes 24345 vs. 24346 when operative note is ambiguous about whether a separate graft was used
Bundling denial when 24345 is billed alongside 24615 (open elbow dislocation) — ligament repair is typically considered included in 24615
Missing laterality modifier (LT or RT) causing claim rejection or routing error on payer systems that require side identification
Insufficient medical necessity documentation — no pre-op imaging, stress testing, or clinical notes establishing valgus instability
Global period conflict when post-op E/M visits are billed without modifier 24 within the 90-day window

Frequently asked questions

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

01What is the difference between 24345 and 24346?

24345 uses local tissue already at the operative site. 24346 requires a free tendon graft harvested from a separate donor location. The operative note must clearly state the tissue source — payers will challenge the code if it's ambiguous.

02Can 24345 be billed with 24615 on the same day?

Generally no. Open treatment of elbow dislocation (24615) includes associated ligament repair. NCCI PTP edits reflect this bundling. You'd need clear documentation that the MCL work was distinctly separate and not integral to the dislocation repair to support unbundling with modifier 59.

03Does 24345 carry a global period, and what does it include?

Yes — 90-day global. It covers the day-before pre-op visit, the surgery itself, and all routine post-op care through day 90. Unrelated E/M visits need modifier 24; unrelated procedures need modifier 79.

04Is modifier 50 appropriate if both elbows are repaired in the same session?

Yes. Bilateral MCL repair in a single operative session is billed with modifier 50 on a single line. Bilateral elbow MCL repairs are rare, so document the bilateral indication clearly — payers may scrutinize the claim.

05When is modifier 22 appropriate for 24345?

Use modifier 22 when the procedure required substantially more work than typical — prior surgery with dense scar, morbid obesity requiring modified positioning, or severely disrupted anatomy. Document the specific factors that increased complexity in the operative note; a generic 22 without supporting narrative will be denied.

06Does site of service affect reimbursement for 24345?

Yes. The HOPD and ASC payment rates differ significantly — see the Site of Service comparison on this page. Performing the case in an ASC versus hospital outpatient department changes the facility payment; the physician professional fee is also subject to the site-of-service differential under the CMS Physician Fee Schedule 2026.

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 tissue source (local vs. graft), surgical approach by name, intraoperative MCL findings, repair technique, and any concurrent procedures from dictation. This prevents the most common audit flag — an operative note that fails to distinguish 24345 (local tissue) from 24346 (free tendon graft) — and ensures laterality is recorded for modifier assignment.

See how Mira captures CPT 24345 documentation