Percutaneous repair of the elbow tendon, performed through a minimally invasive approach without a large open incision.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $384.44
- Total RVUs
- 11.51
- 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 5 cited references ↓
- Specify the approach explicitly as percutaneous — notes stating only 'minimally invasive' without further detail are audit flags.
- Document the specific tendon or structure repaired (e.g., common extensor tendon at lateral epicondyle) and the side (left or right).
- Include failed conservative treatment history: duration of symptoms, prior physical therapy, injections, or bracing tried before surgery.
- Operative note must describe needle or instrument entry site(s), technique used (e.g., tenotomy, ultrasonic debridement), and intraoperative findings.
- If ultrasound guidance was used, document real-time image guidance with permanent record of images and separate interpretation note if billing 76882-26.
- Pre-op diagnosis and post-op diagnosis must align with the ICD-10 code submitted — lateral epicondylitis (M77.1x) is the most common pairing.
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 5 cited references ↓
CPT 24357 describes a percutaneous elbow repair — most commonly applied to lateral epicondyle pathology (tennis elbow) when the surgeon addresses the tendon through a needle-based or small-puncture technique rather than open exposure. The 90-day global period covers all routine post-op management from the day before surgery through day 90. Anything unrelated billed in that window needs modifier 24 (E/M) or 79 (unrelated procedure); a staged or planned related procedure gets modifier 58.
The code is most frequently billed by hand surgeons and, notably, family practice physicians — the latter often performing office-based Tenex-style ultrasonic debridement procedures coded under 24357. When ultrasound guidance is used intraoperatively, some practices append 76882-26 for the imaging component; confirm payer bundling rules before appending, as not all commercial payers allow separate payment.
Site of service matters here. The gap between HOPD and ASC facility payments is significant — see the Site of Service comparison table. Performing this procedure in an ASC rather than an HOPD setting affects the facility fee but not the physician's professional fee, which is set by the CMS Physician Fee Schedule 2026.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 5.3 |
| Practice expense RVU | 5.59 |
| Malpractice RVU | 0.62 |
| Total RVU | 11.51 |
| Medicare national rate | $384.44 |
| 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 | $384.44 |
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 24357 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing or inadequate documentation of failed conservative treatment, which most payers require before approving elbow tendon repair.
- Operative note describes an open approach or debridement inconsistent with percutaneous technique, triggering a code mismatch denial.
- Laterality modifier (LT or RT) absent, causing claim rejection or processing delay on payers that require it for upper extremity codes.
- Ultrasound guidance (76882-26) billed separately when the payer bundles it into 24357 — check payer-specific NCCI edits before appending.
- Global period violation: post-op E/M billed without modifier 24, or a related procedure billed without modifier 78, during the 90-day window.
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01Is 24357 the right code for a Tenex (ultrasonic tenotomy) procedure on the lateral epicondyle?
02What ICD-10 codes most commonly pair with 24357?
03Does the 90-day global period affect how I bill a post-op injection or E/M visit?
04Can 24357 be billed bilaterally in the same session?
05What is the difference between 24357, 24358, and 24359?
06Do I need prior authorization for 24357?
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 percutaneous approach, specific tendon and anatomic location treated, laterality, intraoperative findings, and whether ultrasound guidance was used — pulling these directly from dictation and populating the operative note fields that CMS and commercial payers audit first. That prevents the two most common denials: approach-mismatch (open vs. percutaneous) and missing laterality, both of which trigger manual review or outright rejection.
See how Mira captures CPT 24357 documentation