Open tenotomy of the lateral or medial elbow with debridement of soft tissue and/or bone, performed for conditions such as lateral epicondylitis (tennis elbow) or medial epicondylitis (golfer's elbow).

Verified May 8, 2026 · 7 sources ↓

Medicare: $500.01
Total RVUs: 14.97
Global, days: 90
Region: Elbow

Drawn from CMSAbosAAPCFindacodePayerprice

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify lateral or medial approach by name — 'common extensor origin' or 'common flexor-pronator origin' as appropriate.
Document that the procedure was performed through an open incision, not percutaneously.
Describe the debridement in detail: extent of soft tissue excision, whether bone was debrided, and the pathologic findings encountered (fibrosis, calcification, degenerative tissue).
Confirm no tendon repair or reattachment was performed — if repair was done, 24359 applies instead.
Record the preoperative diagnosis (e.g., lateral epicondylitis, medial epicondylitis) supported by clinical exam findings and, if obtained, imaging or prior conservative treatment failure.
Note the specific elbow (right or left) to support LT/RT modifier application.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 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 7 cited references ↓

CPT 24358 covers an open tenotomy at the lateral or medial elbow combined with debridement of fibrosed or degenerative soft tissue and/or bone. The surgeon incises down to the affected tendon origin — typically the common extensor origin laterally or the common flexor-pronator origin medially — excises the pathologic tissue, and debrids any involved bone. This is the open debridement-only code; if the surgeon also performs repair or reattachment of the tendon after debridement, step up to 24359.

The 24357–24359 family distinguishes three levels of surgical effort: 24357 (percutaneous tenotomy, no debridement), 24358 (open with debridement), and 24359 (open with debridement plus repair/reattachment). Choosing the wrong code in this family is a persistent audit trigger — operative notes must clearly support open access and debridement without repair to justify 24358 over its neighbors.

This code carries a 90-day global period. Routine follow-up, splint checks, and wound care through day 90 are bundled. Modifier 24 is required for any unrelated E/M visit billed within the global window; modifier 78 applies if the patient returns to the OR for a related complication during the postoperative period.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.49
Practice expense RVU	7.2
Malpractice RVU	1.28
Total RVU	14.97
Medicare national rate	$500.01
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	$500.01
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 24358 get rejected.

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

Upcoding flag when operative note documents only percutaneous release without documented open debridement — payers remap to 24357.
Missing distinction between 24358 and 24359: if the note mentions tendon repair or reattachment without a separate 24359 charge, or vice versa, expect a coding mismatch denial.
Lack of documented conservative treatment failure prior to surgery — many payers require documented evidence of physical therapy, injections, or activity modification before approving open epicondylitis surgery.
Bilateral elbow procedures billed without modifier 50 or paired LT/RT modifiers, triggering a duplicate-claim edit.
Services billed within the 90-day global period of a prior elbow procedure without an appropriate modifier (24 for unrelated E/M, 79 for unrelated surgical procedure).

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What separates 24358 from 24357 and 24359?

24357 is percutaneous — no open incision, no debridement. 24358 is open with debridement of soft tissue and/or bone but no tendon repair. 24359 adds formal repair or reattachment after the debridement. The operative note must clearly support each boundary.

02Can 24358 and 24357 be billed together on the same elbow?

No. 24357 and 24358 describe alternative approaches to the same anatomic problem on the same elbow. Billing both on the same side same-day will generate a bundling edit. If bilateral procedures are performed, use LT and RT modifiers or modifier 50.

03What modifier is required when billing an E/M visit during the 90-day global period for an unrelated condition?

Modifier 24 — Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period. Document that the visit reason is distinct from the operative diagnosis.

04Is modifier 50 appropriate for bilateral open epicondylitis debridement in the same session?

Yes. If both elbows are debrided open during a single operative session, append modifier 50 to 24358, or bill 24358-LT and 24358-RT on separate lines. Check individual payer preference — some payers want 50, others want paired LT/RT lines.

05Does failed conservative treatment need to be documented before payers approve 24358?

For most commercial payers and Medicare Advantage plans, yes. Standard criteria include documented failure of at least 6–12 weeks of conservative management (physical therapy, NSAIDs, corticosteroid injection). Without this in the chart, prior authorization is frequently denied and retrospective audits claw back payment.

06When should modifier 78 be used with 24358?

Modifier 78 applies when the patient returns to the OR during the 90-day global period for an unplanned, related procedure — for example, wound dehiscence or infection at the same operative site requiring surgical management. Do not use 78 for an unrelated procedure; that requires modifier 79.

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 surgical approach (lateral vs. medial), confirms open access via incision description, and logs the specific tissue debrided — fibrosed tendon origin, calcific deposits, or bone — along with the absence of tendon repair or reattachment. This prevents the most common 24358 audit flag: an operative note that reads ambiguously between 24357 (percutaneous) and 24359 (open with repair), which triggers payer remapping and recoupment requests.

See how Mira captures CPT 24358 documentation