Arthroplasty of the elbow with prosthetic replacement of both the distal humerus and proximal ulna — i.e., total elbow arthroplasty.

Verified May 8, 2026 · 5 sources ↓

Medicare: $1,300.63
Total RVUs: 38.94
Global, days: 90
Region: Elbow

Drawn from CMSZimmerbiometAetnaAAPC

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 (right or left elbow) in the operative note and on the claim
Document the indication: diagnosis driving the procedure (e.g., rheumatoid arthritis, post-traumatic arthritis, distal humerus fracture, failed prior implant)
Confirm both distal humeral and proximal ulnar prosthetic components were placed — partial replacement (distal humerus only) maps to 24361, not 24363
If replacing a failed prosthesis, document the prior implant removal and state that a new prosthesis was inserted; 24160 must not be billed separately
Record the implant manufacturer, device name, and lot/serial numbers for traceability and payer audit response
Document any significant added complexity (excessive scarring, bone defect, allograft use) if modifier 22 is appended — include time and narrative justification

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 58 Staged or related 59 Distinct service 62 Co-surgeons 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side 24 Unrelated E/M during global 78 Unplanned return — related

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 24363 covers total elbow arthroplasty: the surgeon removes the native joint (or a failed prior prosthesis) and implants coupled humeral and ulnar prosthetic components. Per the NCCI Policy Manual, prosthesis removal is bundled into 24363 — do not separately bill CPT 24160 for removal of a failed implant when you're replacing it in the same session.

24363 carries a 90-day global period. All routine post-op visits, wound care, and stitch removals through day 90 are bundled. Services unrelated to the elbow arthroplasty during that window require modifier 24 (E/M) or 79 (unrelated procedure). A staged revision of individual components after the global posts under 24370 or 24371, not 24363.

This procedure maps to MS-DRGs 483, 507, or 508 on the inpatient side depending on CC/MCC status. On the outpatient side, the case can be performed at an ASC or HOPD — site of service affects payment significantly (see Site of Service comparison). ICD-10-PCS replacement codes for the right elbow (L) and left elbow (M) both use approach 0 (open), device J (synthetic substitute), qualifier Z.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	21.45
Practice expense RVU	13.16
Malpractice RVU	4.33
Total RVU	38.94
Medicare national rate	$1,300.63
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	$1,300.63
HOPD (APC 5116) Hospital outpatient department	$17,913.59
ASC (PI J8) Ambulatory surgical center (freestanding)	$13,753.01

Common denial reasons

The recurring reasons claims for CPT 24363 get rejected.

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

Medical necessity not established — payer requires documented failure of conservative treatment or specific ICD-10 diagnoses; confirm coverage policy before surgery
Unbundling: separately billing CPT 24160 for removal of a failed prosthesis during the same session as 24363 — NCCI bundles these
Missing or incorrect laterality modifier (LT/RT) triggering a claim edit or duplicate-procedure flag
Prior authorization not obtained or obtained for the wrong procedure code (e.g., authorized for 24361 hemiarthroplasty but 24363 total elbow performed)
Post-op E/M visits billed without modifier 24 during the 90-day global period, causing automatic denial

Frequently asked questions

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

01Can I bill CPT 24160 alongside 24363 when I'm removing a failed total elbow before reimplanting?

No. NCCI bundles 24160 into 24363. The removal of a prior failed prosthesis is considered included in the total elbow arthroplasty code. Bill only 24363.

02What's the difference between 24363, 24370, and 24371?

24363 is primary total elbow arthroplasty (both components). 24370 is revision of one component (humeral or ulnar). 24371 is revision of both components. Use 24370/24371 when you're revising a prior total elbow, not performing a primary replacement.

03Does 24363 require laterality modifiers?

Yes. Append LT or RT on every claim. Missing laterality triggers edits at most payers and CMS, and is a top reason for unnecessary denials on this code.

04What ICD-10 diagnoses support medical necessity for total elbow arthroplasty?

Aetna's clinical policy (and most major payers) cover 24363 for rheumatoid/inflammatory arthritis, post-traumatic arthritis, distal humerus fracture, severe joint instability, and ankylosis. Confirm your payer's specific coverage policy — diagnoses like isolated elbow pain (M25.521–M25.529) may require additional documentation of failed conservative care.

05How do I bill for a post-op visit during the 90-day global if the patient presents with an unrelated problem?

Append modifier 24 to the E/M code and document clearly that the visit addressed a condition unrelated to the elbow arthroplasty. Without modifier 24, the claim will auto-deny as bundled into the global period.

06Can total elbow arthroplasty be performed at an ASC?

Yes. 24363 is payable in the ASC setting. The ASC payment rate is lower than the HOPD rate — see the Site of Service comparison on this page. Confirm payer-specific site-of-service policies, as some commercial payers restrict complex joint arthroplasties to inpatient or HOPD settings.

07When is modifier 22 appropriate for 24363?

Use modifier 22 when documented circumstances substantially increase operative work — severe heterotopic ossification, multiple prior surgeries with dense scarring, significant bone defect requiring allograft. The operative note must describe the added difficulty and time. Without that narrative, payers will ignore the modifier and pay at the standard rate.

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 prosthetic components placed (distal humeral and proximal ulnar), laterality, surgical indication, and any prior implant removal from the surgeon's dictation — and flags when only a humeral component is documented so the coder can verify 24363 vs. 24361 before the claim drops. This prevents the most common audit flag: billing 24363 when operative dictation only confirms a hemiarthroplasty.

See how Mira captures CPT 24363 documentation