Open elbow arthroplasty using a biologic membrane (e.g., fascia) to resurface or reconstruct the joint without inserting a prosthetic implant.

Verified May 8, 2026 · 6 sources ↓

Medicare: $837.69
Total RVUs: 25.08
Global, days: 90
Region: Elbow

Drawn from CMSFastrvuUhcproviderAAPC

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the reconstructive material used (e.g., fascia lata, allograft membrane) — absence of this detail is the most common audit flag distinguishing 24360 from 24361/24362
Confirm no prosthetic implant was placed; if any metallic or synthetic component was used, reassess whether 24361, 24362, or 24363 applies
Document surgical approach by name (medial, lateral, posterior, or combined); 'standard approach' language triggers audit scrutiny
Record pre-operative diagnosis with supporting imaging (X-ray or MRI showing arthritic destruction, post-traumatic deformity, or failed prior procedure)
Include range-of-motion findings and functional limitations that justify surgical intervention over continued non-operative management
Note any concurrent procedures performed (e.g., ulnar nerve transposition, synovectomy) with separate documentation supporting individual code capture

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 25 Significant separate E/M 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 XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 24360 covers open reconstruction of the elbow joint using an interpositional membrane — classically fascia lata or a similar biologic tissue — placed between the articulating surfaces to restore function without a metal or polyethylene prosthesis. It sits at the least-invasive end of the elbow arthroplasty spectrum (24360–24363), making code selection depend entirely on what was actually implanted or interposed. If the operative note describes a distal humeral prosthetic component, you're in 24361 territory; if the surgeon placed implant plus fascia lata ligament reconstruction, that's 24362. 24360 is the correct choice only when the reconstruction uses biologic interposition alone.

The 90-day global period covers the day-before visit, the procedure itself, and all routine post-op management through day 90. Unrelated E/M services in that window require modifier 24. A staged or unplanned return to the OR for a related complication bills with modifier 78; an unrelated procedure in the global period uses modifier 79. Physical therapy and separately payable implants are outside the global and bill normally.

Prior authorization is near-universal for elbow arthroplasty. UnitedHealthcare Medicare Advantage explicitly lists 24360 under covered elbow surgery, but most commercial and MA payers require documented failure of conservative treatment, imaging, and functional limitation before approving. Submit those records with the auth request, not after denial.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	12.35
Practice expense RVU	10.11
Malpractice RVU	2.62
Total RVU	25.08
Medicare national rate	$837.69
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	$837.69
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,207.17

Common denial reasons

The recurring reasons claims for CPT 24360 get rejected.

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

Upcoding flags when 24360 is billed but the operative note describes placement of a distal humeral prosthesis — should be 24361 or 24363
Missing or insufficient prior authorization; elbow arthroplasty is a high-scrutiny procedure across Medicare Advantage and most commercial payers
Inadequate documentation of failed conservative management (injections, PT, bracing) required by most payers before approving reconstructive arthroplasty
Global period conflicts when post-op E/M visits are billed without modifier 24 and the payer cannot confirm the visit was for an unrelated condition
Bundling errors when synovectomy or debridement of the same joint is billed separately — per NCCI policy, debridement of the operative joint is included in the arthroplasty code

Frequently asked questions

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

01What distinguishes 24360 from 24361 and 24362?

24360 = biologic interposition only (no prosthesis). 24361 = distal humeral prosthetic replacement. 24362 = implant plus fascia lata ligament reconstruction. The operative note must specify what was implanted or interposed — the code follows the hardware, not the diagnosis.

02Can 24360 and 24363 (total elbow) ever be billed together?

No. They are mutually exclusive procedures on the same joint. 24363 describes total elbow replacement with both distal humeral and proximal ulnar components; 24360 is a non-prosthetic reconstruction. Bill the code that matches what was actually performed.

03Is a debridement of the elbow separately billable when performed at the same time as 24360?

No. NCCI policy bundles debridement of the operative joint into the arthroplasty code. Debridement of a different joint or a site unrelated to the elbow may be separately reported with modifier 59 or XS if documentation supports it.

04How do you handle billing for ulnar nerve transposition performed during the same elbow arthroplasty session?

Ulnar nerve transposition (64718) is separately reportable from elbow arthroplasty per NCCI policy. Append modifier 59 or XU to 64718 to bypass the NCCI PTP edit and include documentation that transposition was performed as a distinct procedure.

05Does 24360 require prior authorization, and what documentation supports the auth?

Most commercial and Medicare Advantage payers require prior auth for elbow arthroplasty. Submit imaging (X-ray or MRI), documentation of failed conservative treatment (duration, modalities tried), and functional limitation data. UnitedHealthcare Medicare Advantage explicitly lists 24360 under covered elbow surgery, but auth is still required before scheduling.

06Which modifier applies if the surgeon must return to the OR within the 90-day global period to manage a wound complication from the original 24360?

Modifier 78 — unplanned return to the OR for a complication related to the original procedure. Do not use modifier 79 (that is for an unrelated procedure during the global period). Document clearly in the operative note that the return was prompted by a complication of the index arthroplasty.

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 reconstructive material (fascia lata, allograft, or other biologic membrane), surgical approach by name, absence or presence of any prosthetic component, and concurrent procedures such as ulnar nerve transposition or synovectomy. That distinction between interposition-only and prosthetic reconstruction is exactly what separates 24360 from 24361–24363 at audit — a vague operative note that omits graft type is the fastest path to a code-level denial or a RAC query.

See how Mira captures CPT 24360 documentation