Elbow arthroplasty with replacement of the distal humerus using a prosthetic implant — hemiarthroplasty of the elbow, humeral side only.

Verified May 8, 2026 · 5 sources ↓

Medicare: $930.55
Total RVUs: 27.86
Global, days: 90
Region: Elbow

Drawn from CMSCisejournalFaculty

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify laterality (left or right elbow) — required for modifier LT or RT
Identify the surgical approach by name (posterior, lateral, medial parapatellar equivalent for elbow — e.g., posterior triceps-splitting, triceps-reflecting, Bryan-Morrey)
Document ulnar nerve status: identified, protected, and whether transposition was performed (transposition is separately reportable as 64718)
State that this is distal humeral replacement only — not total elbow — to justify 24361 over 24363
Document implant manufacturer, model, and lot number for prosthesis traceability
Record preoperative diagnosis with ICD-10 specificity (e.g., rheumatoid arthritis, post-traumatic arthritis, distal humeral fracture) and confirm conservative treatment failure where applicable
If revision of prior failed prosthesis, document that prosthesis removal is part of the arthroplasty — do not create a separate operative note entry implying 24160 was a standalone procedure

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 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 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

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

24361 covers elbow arthroplasty in which the diseased or damaged distal humerus is resected and replaced with a prosthetic component. This is a hemi-arthroplasty — the humeral side only — distinguishing it from 24363, which replaces both the distal humerus and proximal ulna (total elbow). The procedure involves a posterior or lateral approach, ulnar nerve identification and protection, triceps mobilization, resection of the distal humeral articulating surface, and implantation of the humeral prosthesis. Ulnar nerve transposition, if performed, is separately reportable.

The 90-day global period bundles the day-before visit, the surgery itself, and all routine post-op care through day 90. Unrelated E/M visits in that window require modifier 24. A new problem presenting during the global that requires a significant, separately documented E/M requires modifier 24 with clear documentation that the visit was for a condition unrelated to the arthroplasty.

NCCI explicitly prohibits billing 24160 (prosthesis removal with debridement/synovectomy) separately when the prior implant is removed as part of the 24361 revision — removal is bundled into the arthroplasty code. Similarly, same-joint arthrocentesis on the day of surgery cannot be billed separately.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	14.05
Practice expense RVU	10.81
Malpractice RVU	3
Total RVU	27.86
Medicare national rate	$930.55
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	$930.55
HOPD (APC 5116) Hospital outpatient department	$17,913.59
ASC (PI J8) Ambulatory surgical center (freestanding)	$14,723.24

Common denial reasons

The recurring reasons claims for CPT 24361 get rejected.

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

Laterality missing or not coded — payers require LT or RT; claims without it often reject outright
24160 billed same-day: NCCI bundles prosthesis removal into 24361 when performed as part of revision arthroplasty — 24160 will be denied
Insufficient medical necessity documentation — no documented failure of conservative management for non-traumatic indications such as rheumatoid or osteoarthritis
Upcoded to 24363 by error — if only the humeral component is replaced, 24363 is incorrect and will be scrutinized or denied on audit
Same-day arthrocentesis of the elbow billed separately — NCCI prohibits 20605 with an open elbow procedure on the same joint
Global period violations — E/M services billed during the 90-day global without modifier 24 and documentation that the visit was for an unrelated condition

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What is the difference between 24361 and 24363?

24361 replaces only the distal humerus. 24363 replaces both the distal humerus and proximal ulna — a true total elbow. If both components are implanted, use 24363. Using 24361 when both components are placed is an undercoding error that will not hold up on audit.

02Can I bill 24160 separately when removing a failed humeral implant before placing the new one?

No. NCCI (2026 Policy Manual, Chapter 4, Rule 18) explicitly bundles 24160 into 24361 when prosthesis removal is part of the arthroplasty. Billing both will result in denial of 24160.

03Can I bill an ulnar nerve transposition performed during the same session?

Yes. Ulnar nerve transposition at the elbow (64718) is separately reportable with 24361. Append modifier 59 or XU to 64718 if an NCCI PTP edit fires, and document the transposition as a distinct procedure in the operative note.

04What modifiers are needed for a bilateral elbow arthroplasty?

Bilateral elbow arthroplasty in a single session is rare but would require modifier 50 (or LT and RT on separate lines, depending on payer preference). Some payers require prior authorization for bilateral procedures — verify before the case.

05How do I handle an E/M visit during the 90-day global period?

Any E/M for the elbow arthroplasty itself is bundled — do not bill it. If the visit is for a genuinely unrelated condition, append modifier 24 and document explicitly that the visit addressed a problem unrelated to the arthroplasty. Vague documentation will not support the modifier on appeal.

06Is a same-day elbow injection billable alongside 24361?

No. NCCI prohibits reporting arthrocentesis (e.g., 20605) separately when an open procedure is performed on the same joint in the same session. If the injection was on a different joint, it is separately reportable.

07Which ICD-10 codes most commonly support 24361?

Rheumatoid arthritis of the elbow (M05.721/M05.722), post-traumatic osteoarthritis of the elbow (M12.821/M12.822), and primary osteoarthritis of the elbow (M19.021/M19.022) are the most common supporting diagnoses. Distal humeral fracture sequelae may also apply. Specificity to laterality in the ICD-10 code must match the modifier on the claim.

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 by name, ulnar nerve management, laterality, implant details, and an explicit statement that only the distal humeral component was replaced (not total elbow). This prevents the two most common audit flags: operative notes that don't distinguish 24361 from 24363, and notes that ambiguously describe prosthesis removal in a way that prompts coders to incorrectly add 24160.

See how Mira captures CPT 24361 documentation