Arthroplasty of the radial head, performed as an open surgical reconstruction of the proximal radius at the elbow joint.

Verified May 8, 2026 · 6 sources ↓

Medicare: $605.56
Work RVU: 8.4
Global, days: 90
Region: Elbow

Drawn from CMSMdclarityPayerpriceAAPCNIH

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 operative approach by name (lateral, Kocher, etc.) — 'standard approach' flags audits
Document intraoperative findings, including the condition of the radial head and articular surface, to support medical necessity
Confirm that native radial head reconstruction — not excision or prosthetic replacement — was performed
Record laterality explicitly (right or left elbow) in both the operative note and the diagnosis
Include pre-operative imaging (X-ray or CT) showing the pathology requiring reconstruction
Note the absence or presence of associated ligamentous or osseous injuries addressed in the same session

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 52 Reduced services 24 Unrelated E/M during global 25 Significant separate E/M 57 Decision for surgery 58 Staged or related 78 Unplanned return — related 79 Unrelated during global 62 Co-surgeons 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 24365 covers open arthroplasty of the radial head — a procedure that reshapes or reconstructs the proximal end of the radius where it articulates with the capitellum and proximal ulna. It is distinct from radial head excision (24130) and from prosthetic replacement with an implant (24366). The surgeon reconstructs the native radial head rather than excising or replacing it with a prosthesis. Indications typically include fracture sequelae, post-traumatic deformity, or degenerative changes at the radiocapitellar joint.

This code carries a 90-day global period. All routine elbow follow-up, dressing changes, and wound checks through post-op day 90 are bundled into the surgical payment. Unrelated E/M visits or procedures during the global window require modifier 24 or 79, respectively. Modifier 78 applies only if the patient returns to the OR for an unplanned complication directly related to the original reconstruction.

Laterality matters here. Bill with LT or RT to specify the operative side. Bilateral radial head arthroplasty in the same session — an uncommon scenario — requires modifier 50 and supporting documentation showing independent medical necessity for each side.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (8.4) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (18.13) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.4
Practice expense RVU	7.95
Malpractice RVU	1.78
Total RVU	18.13
Medicare national rate	$605.56
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	$605.56
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$10,016.17

Common denial reasons

The recurring reasons claims for CPT 24365 get rejected.

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

Missing laterality modifier (LT/RT) — many payers auto-deny elbow surgery claims without a side specified
Code billed when prosthetic implant was placed, which maps to 24366 rather than 24365
Global period conflict — post-op E/M visits billed without modifier 24 during the 90-day window
Medical necessity not supported when pre-op imaging or detailed intraoperative findings are absent from documentation
Unbundling with radial head excision (24130) performed in the same session on the same elbow

Frequently asked questions

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

01What is the difference between CPT 24365 and CPT 24366?

24365 covers reconstruction of the native radial head without a prosthetic implant. 24366 is used when a metallic or synthetic radial head prosthesis is inserted. If an implant goes in, 24366 is the correct code — billing 24365 in that scenario is a misrepresentation of the procedure.

02Do I need a laterality modifier for 24365?

Yes. Append LT or RT on every claim. Most payers — including many MACs — will auto-deny or pend elbow surgical claims without a laterality modifier. This is not optional documentation; it is a claim requirement.

03Can I bill 24365 and 24130 (radial head excision) together on the same day for the same elbow?

No. Radial head excision and radial head reconstruction are mutually exclusive for the same elbow in the same session. Billing both is an unbundling error subject to NCCI edit denial.

04How does the 90-day global period affect post-op billing?

All routine follow-up care through post-op day 90 is bundled into the 24365 payment. To bill an E/M visit during the global for an unrelated condition, append modifier 24 and document that the visit was not for routine surgical aftercare. A return to the OR for a complication directly related to the reconstruction uses modifier 78.

05When is modifier 62 (co-surgery) appropriate for 24365?

Modifier 62 applies when two surgeons are each required to perform distinct portions of the radial head reconstruction, and each surgeon's role is documented separately in the operative note. Both surgeons bill 24365-62. CMS reimburses each at 62.5% of the fee schedule amount. Verify that 24365 carries a co-surgery indicator of 1 in the MPFS database before billing.

06Is 24365 performed in an ASC or hospital outpatient setting?

Both are common sites of service. The HOPD and ASC payments differ — see the Site of Service comparison on this page. The procedure is reported the same way regardless of setting; the site-of-service differential is reflected in facility payment, not in your physician 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 surgeon's dictated operative approach, the intraoperative condition of the radial head, the specific reconstruction technique performed, and laterality — all in the operative note. That prevents the two most common audit flags: a vague approach description and a missing side designation that triggers auto-denial at payer adjudication.

See how Mira captures CPT 24365 documentation