Open elbow tenotomy with soft tissue and/or bone debridement plus tendon repair or reattachment, performed at the lateral or medial epicondyle for conditions such as epicondylitis.

Verified May 8, 2026 · 7 sources ↓

Medicare: $616.91
Total RVUs: 18.47
Global, days: 90
Region: Elbow

Drawn from CMSAAPCFindacodePayerpriceMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify whether the approach is lateral (epicondylitis/tennis elbow) or medial (golfer's elbow) — both cannot be implied from a single unit
Explicitly document tendon repair or reattachment technique (e.g., suture anchor brand/size, suture type, anatomic reattachment site) — debridement alone does not support 24359
Describe debridement in detail: extent of degenerative tissue excised, any osteophyte removal, and decortication or preparation of bony bed
Document failed conservative treatment (physical therapy, injections, duration) to support medical necessity for open surgical intervention
Record anesthesia type, patient positioning, tourniquet use, and intraoperative findings including degree of tendon degeneration or tearing
If bilateral epicondyle work is performed in the same session, document each side separately with independent findings and repair descriptions to support two units of 24359

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 59 Distinct service LT Left side RT Right side 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 24359 describes an open surgical procedure at the elbow in which the surgeon performs a tenotomy (lateral or medial), debrides diseased soft tissue and/or bone at the epicondyle, and then repairs or reattaches the involved tendon. The debridement and tenotomy are subordinate steps — tendon repair or reattachment is the defining element that separates 24359 from its sibling code 24358. If the operative note shows debridement only, without repair or reattachment, 24359 is unsupported; use 24358 instead.

The procedure addresses chronic epicondylitis (tennis elbow laterally, golfer's elbow medially) that has failed conservative management. Surgically, this typically involves excising frayed or degenerative tendon tissue at the epicondylar insertion, debriding osteophytes or decortication of bone to prepare a healing bed, and anchoring or suturing the tendon back to its anatomic origin. Common fixation includes suture anchors placed at the epicondyle.

With a 90-day global period, all routine post-op elbow visits, dressing changes, and suture removal through day 90 are bundled. If both the lateral and medial sides of the same elbow are repaired in the same session, 24359 is billed twice — not once with modifier 22. The second unit requires modifier 59 (or XS for Medicare) to distinguish the separate anatomic site; modifier 50 is not appropriate because the code descriptor specifies lateral or medial, not bilateral elbows.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.76
Practice expense RVU	7.97
Malpractice RVU	1.74
Total RVU	18.47
Medicare national rate	$616.91
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	$616.91
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 24359 get rejected.

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

Operative note documents debridement only with no tendon repair or reattachment — 24358 is the correct code in that scenario
Bilateral modifier 50 applied to same-elbow medial and lateral repairs — the code is site-specific, not bilateral; second unit needs modifier 59 or XS
Insufficient documentation of failed conservative treatment, triggering medical necessity denial from commercial payers
Modifier 22 appended for performing both medial and lateral repairs instead of billing two units of 24359 with modifier 59/XS
Global period violation — post-op elbow visits billed without modifier 24 when they fall within the 90-day global window and are related to the surgery

Frequently asked questions

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

01What is the difference between 24358 and 24359?

24358 covers debridement with tenotomy only. 24359 requires tendon repair or reattachment in addition to the debridement. If the surgeon does not repair or reattach the tendon, 24359 is overcoded — use 24358.

02Can 24359 be billed twice if the surgeon works on both the medial and lateral epicondyle of the same elbow?

Yes. When both sides are repaired, bill 24359 twice. The second unit gets modifier 59 (or XS for Medicare). Do not use modifier 22 or modifier 50 for this scenario — 50 is for the same procedure on bilateral elbows, and 22 is for a single procedure requiring substantially increased work.

03What global period applies to 24359, and what does that mean for post-op billing?

24359 carries a 90-day global. Routine follow-up visits, dressing changes, and suture removal within that window are bundled and not separately billable. Bill unrelated E/M services with modifier 24; new problems in the same 90-day window need modifier 25 on a same-day visit.

04Is modifier 50 correct for bilateral elbow epicondyle repairs done in the same session?

Modifier 50 applies only when the identical procedure is performed on the contralateral (opposite) elbow in the same session. Use LT and RT to distinguish sides. For medial and lateral work on the same elbow, bill two units with modifier 59 or XS on the second.

05Which ICD-10 codes most commonly pair with 24359?

M77.1x (lateral epicondylitis) supports lateral-side cases; M77.0x (medial epicondylitis) supports medial cases. Append the appropriate laterality character (1 for right, 2 for left). Some payers also accept M75.12x for rotator-origin tendinopathy crosswalks, but epicondylitis-specific codes are the cleaner match.

06Can 24359 and 24343 (lateral collateral ligament repair) be billed together?

Check NCCI edits before billing both on the same date. If the ligament repair and tendon reattachment are distinct procedures on different structures with separate documentation, modifier 59 may override the bundle — but the operative note must clearly delineate each repair as an independent service.

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 specific epicondylar side (lateral vs. medial), the debridement details (tissue excised, osteophyte removal, decortication), the repair method (anchor type, suture technique, anatomic reattachment site), and the intraoperative findings describing degree of tendon degeneration. That documentation chain prevents the most common 24359 denial: a note that describes debridement without explicitly confirming repair or reattachment, which auditors and automated claim edits use to downcode the claim to 24358.

See how Mira captures CPT 24359 documentation