Elbow arthroplasty using a distal humeral implant combined with fascia lata graft harvest and ligament reconstruction to restore joint stability.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $975.97
- Total RVUs
- 29.22
- 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 ↓
- Operative note must identify the specific implant placed at the distal humerus, including manufacturer and component size
- Document the fascia lata graft harvest site (thigh) and graft dimensions used for ligament reconstruction
- Describe the joint capsule reconstruction technique by name — do not use 'standard approach' or 'routine reconstruction'
- Specify the surgical approach to the elbow (lateral, medial, posterior, combined) with anatomical landmarks
- Preoperative diagnosis with supporting imaging must correlate to the reconstructive procedure performed
- If concurrent nerve procedure performed, document nerve condition, technique, and medical necessity separately
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 24362 covers reconstruction of the elbow joint using a prosthetic implant fitted to the distal humerus combined with a fascia lata ligament reconstruction. The fascia lata graft is harvested from the thigh and used to rebuild the joint capsule and ligamentous support around the implant — distinguishing this code from 24361 (distal humeral prosthetic replacement alone) and 24363 (total elbow with proximal ulnar component). Use 24362 when the operative note documents both the humeral prosthesis and the fascia lata harvest and reconstruction; if only the humeral prosthesis is placed without ligament reconstruction, 24361 applies.
The 90-day global period covers the day before surgery, the surgical day, and all routine post-op management through day 90. Separate E/M visits during that window require modifier 24 (unrelated) or 25 (significant, separately identifiable, same-day pre-op). New problems, fractures, or contralateral elbow issues arising in the global period are billable with modifier 79.
NCCI bundles several elbow procedures as components of arthroplasty. Arthrocentesis of the same joint on the same date is not separately reportable. Ulnar nerve transposition (64718) is separately reportable with modifier 59 or XU when performed alongside elbow tendon work, per CMS NCCI Chapter 4 guidance — verify the same logic applies to your arthroplasty-adjacent scenario against the current PTP edit table before billing.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 14.94 |
| Practice expense RVU | 11.1 |
| Malpractice RVU | 3.18 |
| Total RVU | 29.22 |
| Medicare national rate | $975.97 |
| 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 | $975.97 |
HOPD (APC 5115) Hospital outpatient department | $13,116.76 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $9,667.45 |
Common denial reasons
The recurring reasons claims for CPT 24362 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Wrong code selection — 24361 used when fascia lata reconstruction was also performed, or 24363 used when the ulnar component was not implanted
- Missing documentation of fascia lata graft harvest; payers audit for evidence of the ligament reconstruction component that distinguishes 24362 from adjacent codes
- Unbundling denial when arthrocentesis of the same elbow joint is billed separately on the same date of service
- Global period violation — E/M services billed without modifier 24 or 25 during the 90-day post-op window
- ICD-10 diagnosis mismatch — degenerative or traumatic diagnosis not clearly supporting the need for implant plus ligament reconstruction
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01What separates 24362 from 24361 and 24363?
02Can I bill 24362 and 24363 together if the procedure evolves intraoperatively?
03Is ulnar nerve transposition separately billable with 24362?
04What modifiers apply when billing 24362 during another surgeon's global period?
05Does modifier 22 apply to 24362, and what documentation supports it?
06Can 24362 be billed same-day with a fascia lata harvest code?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/files/document/medicare-ncci-policy-manual-2024-chapter-4.pdf
- 03cgsmedicare.comhttps://www.cgsmedicare.com/medicare_dynamic/j15/partb/ptpb/ptp.aspx
- 04fastrvu.comhttps://fastrvu.com/cpt/24362
- 05findacode.comhttps://www.findacode.com/cpt/24362-cpt-code.html
Mira AI Scribe
Mira's AI scribe captures the distal humeral implant details (type, manufacturer, size), fascia lata harvest site and graft dimensions, the ligament reconstruction technique, and the named surgical approach to the elbow from the surgeon's dictation. This prevents the single most common audit flag for 24362: operative notes that document a prosthesis without explicitly describing the fascia lata harvest and reconstruction, which reviewers use to downcode to 24361.
See how Mira captures CPT 24362 documentation