Surgical reconstruction of the elbow's medial collateral ligament using a tendon graft, including harvesting of that graft.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,030.42
Total RVUs: 30.85
Global, days: 90
Region: Elbow

Drawn from AAPCMdclarityAbosCMS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Explicit documentation of tendon graft use, including graft source (palmaris longus, gracilis, etc.)
Clinical rationale for reconstruction over primary repair — e.g., chronic tear, retracted ligament, friable or diseased tissue
Operative note identifies the ligament by name or accepted abbreviation (MCL, UCL) on the medial side
Documentation of graft harvest technique, even though harvest is bundled into 24346
Diagnosis code consistent with MCL/UCL pathology — chronic instability, UCL tear, or valgus instability
Laterality documented (left vs. right elbow) to support LT/RT modifier assignment

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 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 LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 24346 covers reconstruction of the elbow's medial collateral ligament (MCL/UCL) with a tendon graft — graft harvest is bundled into the code, not separately billable. This is Tommy John surgery. The key distinction from 24345 is the use of a graft: if the surgeon used local tissue only, that's a repair (24345); if a graft was harvested and used to reconstruct the ligament, that's 24346. The trigger is usually a chronic or irreparable tear — retracted, diseased, or friable tissue that won't hold a primary repair.

The 90-day global period covers the day-before visit, the procedure, and all routine post-op management through day 90. E/M services during that window need modifier 24 to be separately billable. Any unplanned return to the OR for a related complication during the global period requires modifier 78; an unrelated procedure in the same window takes modifier 79.

This procedure is performed almost exclusively in the outpatient or ASC setting. The HOPD and ASC facility payments differ substantially — see the Site of Service comparison table. Surgeon documentation must clearly support reconstruction with graft rather than simple repair; audit teams look specifically for the word 'graft,' the graft source, and a clinical rationale explaining why primary repair was not feasible.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	14.83
Practice expense RVU	12.86
Malpractice RVU	3.16
Total RVU	30.85
Medicare national rate	$1,030.42
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	$1,030.42
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI G2) Ambulatory surgical center (freestanding)	$6,804.43

Common denial reasons

The recurring reasons claims for CPT 24346 get rejected.

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

Code billed as repair (24345) when operative note documents graft use — or vice versa, 24346 billed without graft documentation
Graft harvest billed separately (e.g., with a tendon harvest code) when harvest is already bundled in 24346
E/M visit during the 90-day global period submitted without modifier 24, triggering automatic denial
Laterality modifier missing when payer requires LT or RT for unilateral elbow procedures
Diagnosis code mismatch — acute traumatic tear coded when documentation supports chronic degenerative pathology, or vice versa

Frequently asked questions

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

01What's the difference between 24345 and 24346?

24345 is repair using local tissue only — no graft. 24346 is reconstruction with a tendon graft, and graft harvest is included. The operative note must document a graft to support 24346. If your surgeon just says 'repair' without mentioning a graft, default to 24345.

02Is Tommy John surgery billed with 24346?

Yes. Tommy John surgery is ulnar collateral ligament reconstruction with a tendon graft — that's exactly what 24346 describes. You'll often see 'UCL reconstruction' or 'Tommy John' in the op note; both map to 24346.

03Can the tendon harvest be billed separately?

No. Graft harvest is bundled into 24346 per the code definition. Billing a separate harvest code alongside 24346 is incorrect unbundling and will be denied or recouped on audit.

04What modifiers are needed if this is done on both elbows in the same session?

Append modifier 50 for a bilateral procedure, or use LT and RT on separate line items depending on payer preference. Bilateral elbow reconstruction is rare, so expect payer scrutiny — have documentation ready.

05How do you bill an E/M visit that occurs during the 90-day global period?

Use modifier 24 on the E/M code if the visit is unrelated to the surgery. If it's a new problem requiring a decision about a new major procedure, modifier 57 applies. Routine post-op visits within the global are not separately billable at all.

06Can 24346 be billed same-day with an elbow arthroscopy?

Only if the arthroscopy addresses a distinctly separate anatomic problem. Append modifier 59 (or XS for a separate structure) and document medical necessity for each procedure independently. Payers may bundle these; expect scrutiny and have the operative note detail each distinct service.

07What ICD-10 diagnosis codes typically support 24346?

Medial instability of the elbow (M24.321/M24.322), sprain of ulnar collateral ligament (S53.441A/subsequent encounter codes), and chronic ligamentous laxity are the most common. Match acuity (acute vs. chronic) to what the operative note actually documents — mismatches are a top denial trigger.

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 graft type and harvest site directly from surgeon dictation, flags whether the operative note uses the terms 'repair' versus 'reconstruction,' and records the clinical rationale for reconstruction (e.g., retracted ligament, chronic tear, friable tissue). This prevents the most common 24345/24346 mix-up and ensures the documentation can withstand a medical necessity audit without a call back to the surgeon.

See how Mira captures CPT 24346 documentation