Surgical · Elbow

Surgical cutting and realignment of the humerus (upper arm bone), with or without placement of internal fixation hardware to hold the corrected position.

Verified May 8, 2026 · 6 sources ↓

Medicare: $774.90
Total RVUs: 23.2
Global, days: 90
Region: Elbow

Drawn from CMSNIHFastrvuFindacodeAAPC

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 indication: congenital deformity, malunion, post-traumatic malalignment, or other correctable deformity with clinical rationale.
Document the exact osteotomy site on the humerus (proximal, shaft, or distal) and the degree of angular or rotational correction achieved.
State whether internal fixation was applied and, if so, identify the hardware type (plate and screws, intramedullary device, etc.).
Record pre-operative imaging (X-ray, CT) confirming the deformity and post-operative imaging confirming correction.
Note the surgical approach by name — do not use vague language like 'standard approach'; audit teams flag operative notes that lack specificity.
If modifier 22 is appended, include a separate attestation in the operative note detailing why the procedure required substantially more work than typical.

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 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 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 6 cited references ↓

CPT 24400 covers an osteotomy of the humerus — the surgeon makes a deliberate cut through the upper arm bone to correct angular deformity, rotational malalignment, or congenital deformity, then stabilizes the corrected position with or without plates, screws, or other internal fixation. The classic indication is a rotational humeral osteotomy for congenital deformity that limits external rotation, but the code also applies to corrective osteotomies for malunion or post-traumatic deformity of the humeral shaft or proximal humerus.

This is a 90-day global procedure. Pre-op visits the day before and all routine post-op care through day 90 are included in the surgical payment. Use modifier 24 for unrelated E/M services during the global and modifier 78 for an unplanned return to the OR for a related complication. Internal fixation hardware removal, if performed as a necessary integral component of a subsequent revision, is not separately billable under NCCI policy.

Site of service matters here — see the HOPD vs. ASC payment comparison table. The gap is substantial, and payers occasionally audit facility vs. non-facility place-of-service claims when the billed site doesn't match the operative report header.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	11.05
Practice expense RVU	9.81
Malpractice RVU	2.34
Total RVU	23.2
Medicare national rate	$774.90
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	$774.90
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 24400 get rejected.

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

Missing or inadequate medical necessity documentation — payers require imaging and clinical notes confirming a correctable deformity that failed or is not amenable to conservative management.
Incorrect place-of-service code that doesn't match the facility listed in the operative report, triggering a site-of-service mismatch denial.
Unbundling of internal fixation — some payers flag separately billed hardware application codes when 24400 already includes fixation as an included service.
Global period violations — E/M or post-op visits billed without modifier 24 or 25 during the 90-day global window are routinely denied.
Laterality not specified — claims lacking modifier LT or RT are returned by payers that require side designation for upper extremity procedures.

Frequently asked questions

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

01Does 24400 include internal fixation, or should I bill hardware placement separately?

The code descriptor explicitly covers the osteotomy 'with or without internal fixation.' Hardware application is bundled — do not separately bill plate or screw fixation codes when performed as part of this osteotomy.

02What is the global period for 24400, and what needs a modifier during that window?

24400 carries a 90-day global period. All routine post-op visits, wound checks, and dressing changes are included. Bill unrelated E/M services with modifier 24, same-day separately identifiable E/M with modifier 25, and any unplanned return to the OR for a related complication with modifier 78.

03Can 24400 be billed bilaterally if both humeri are corrected in the same session?

Yes. For professional claims, append modifier 50 to a single line. For ASC facility claims, follow NCCI guidance and bill two lines with modifiers LT and RT respectively. Payment is capped at 150% of the single-procedure rate under most payer contracts.

04What ICD-10 diagnoses commonly support 24400?

Commonly paired diagnoses include congenital deformity of the humerus, humeral malunion following fracture, and acquired angular deformity of the upper arm. The diagnosis must be supported by imaging and documented functional impairment — 'deformity' alone without clinical correlation routinely triggers medical necessity denials.

05Is modifier 22 ever appropriate for 24400?

Yes, when the osteotomy requires substantially more work than typical — for example, a severely malunited humerus with dense callus requiring extensive bone work. The operative note must explicitly describe what made the procedure harder, including estimated additional time and complexity. Appending modifier 22 without supporting documentation is an audit risk.

06How does 24400 differ from 24410?

24400 covers a single osteotomy of the humerus. CPT 24410 covers multiple osteotomies with realignment on an intramedullary rod (Sofield-type procedure), which is a more complex correction. Bill 24410 when the Sofield technique with IM rod realignment is performed; do not upcode a single osteotomy to 24410.

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 osteotomy site (proximal, shaft, or distal humerus), the type and degree of deformity corrected, the surgical approach by name, and whether internal fixation hardware was placed — including implant type. That level of specificity prevents the two most common denials on 24400: medical necessity rejections from vague operative notes and unbundling flags from ambiguous fixation documentation.

See how Mira captures CPT 24400 documentation