Radial head arthroplasty with prosthetic implant — the damaged radial head is excised and replaced with an artificial prosthesis to restore elbow stability and function.

Verified May 8, 2026 · 6 sources ↓

Medicare: $635.29
Total RVUs: 19.02
Global, days: 90
Region: Elbow

Drawn from CMSAAPCHealthnetGenhealthPayerprice

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 clinical indication — arthritis, chronic joint destruction, or other non-fracture etiology — to distinguish from fracture-indication code 24666
Document failure of conservative treatment (3–6 months of NSAIDs, DMARDs, or glucocorticoids) when the indication is arthritis or degenerative joint destruction
Record the surgical approach by name (lateral Kocher, Kaplan, or other); notes that say 'standard lateral approach' are flagged on audit
Name the implant type, manufacturer, and size inserted and confirm fixation method in the operative note
Document pre-operative elbow stability assessment and intraoperative range-of-motion check after implant seating
Include radiographic evidence of radial head joint destruction in the medical record when the indication is arthritic destruction

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 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 24366 covers radial head arthroplasty with implant: the surgeon accesses the lateral elbow, removes the damaged radial head, prepares the proximal radial canal, and seats a prosthetic implant. This code applies to chronic or degenerative indications — advanced radial head joint destruction from arthritis or failed conservative treatment. It does not apply when a fracture is the primary driver of the procedure.

For acute fracture cases requiring radial head excision and prosthetic replacement, use 24666 instead. Reporting both 24366 and 24666 together will be denied — they describe the same operative construct for different indications. Determine which code matches the documented clinical indication and report only that one.

Payers including Centene-affiliated plans treat radial head implant as medically necessary for Mason/Hotchkiss Type III comminuted or irreparable fractures (24666 territory) and for advanced radial head joint destruction that has failed 3–6 months of conservative pharmacologic therapy (24366 territory). Prior authorization is common. Supporting ICD-10 must align: M06.821/M06.822 for rheumatoid arthritis or S52.121/S52.122 for displaced radial head fractures map to different codes. The 90-day global period covers all routine post-op care; anything unrelated in that window needs modifier 24.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.13
Practice expense RVU	8.04
Malpractice RVU	1.85
Total RVU	19.02
Medicare national rate	$635.29
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	$635.29
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$9,945.25

Common denial reasons

The recurring reasons claims for CPT 24366 get rejected.

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

Wrong code for indication — billing 24366 when the operative note documents an acute fracture; payers redirect to 24666
Bundling denial when 24366 and 24666 are billed together on the same claim for the same operative session
Missing prior authorization — many payers treat radial head implant as a pre-auth-required service and deny without it
Inadequate documentation of conservative treatment failure when indication is arthritis or degenerative destruction
ICD-10 mismatch — fracture diagnosis codes paired with 24366 instead of 24666 trigger medical necessity edits

Frequently asked questions

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

01What is the difference between CPT 24366 and CPT 24666?

24366 is for radial head arthroplasty in chronic or degenerative conditions — arthritis, advanced joint destruction — where no acute fracture is the primary driver. 24666 is for open treatment of a radial head or neck fracture with prosthetic replacement. They describe the same operation but for different indications. Never bill both on the same claim.

02Can I bill 24366 and 24666 together on the same operative report?

No. Payers will deny one as a duplicate or mutually exclusive bundle. Review the documented indication and choose the single code that matches: fracture treatment goes to 24666; chronic/arthritic destruction goes to 24366.

03Does CPT 24366 require prior authorization?

Most commercial payers and some Medicaid managed care plans require prior authorization for radial head implant procedures. Centene-affiliated Health Net plans have a published clinical policy (CP.MP.148) with specific medical necessity criteria. Check payer-specific requirements before scheduling.

04What is the global period for 24366?

90 days. That covers the day before surgery, the procedure itself, and all routine post-op visits through day 90. Unrelated E&M visits during the global period need modifier 24. A return to the OR for an unrelated procedure needs modifier 79.

05Which ICD-10 codes support medical necessity for 24366?

M06.821 and M06.822 (other specified rheumatoid arthritis, right and left elbow) are commonly cited for the arthritic indication. Displaced fracture codes S52.121 and S52.122 map to the fracture indication — but those cases should route to 24666, not 24366.

06Is modifier 50 appropriate for bilateral radial head arthroplasty?

Bilateral radial head replacement is exceptionally rare clinically, but if performed in the same session, modifier 50 applies. Verify individual payer policy — some require LT and RT on separate lines instead of a single line with modifier 50.

07What site of service is appropriate for 24366?

Radial head arthroplasty is performed in a hospital operating room (POS 22) or an ASC (POS 24). The HOPD and ASC facility payments differ significantly — see the site of service comparison table on this page.

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 clinical indication (chronic joint destruction vs. fracture), the lateral surgical approach by name, implant manufacturer and size, intraoperative stability and ROM findings, and the documented history of failed conservative treatment. That specificity prevents the most common denial: a fracture ICD-10 paired with 24366 when 24666 was the correct code — a mismatch that triggers automatic medical necessity edits.

See how Mira captures CPT 24366 documentation