Surgical · Elbow

Multiple osteotomies of the humeral shaft with realignment stabilized by an intramedullary rod (Sofield type procedure).

Verified May 8, 2026 · 6 sources ↓

Medicare: $976.98
Total RVUs: 29.25
Global, days: 90
Region: Elbow

Drawn from CMSAAPCFacultyEmednyAAOS

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Number and location of individual osteotomy cuts along the humeral shaft
Clinical indication establishing medical necessity for multiple osteotomies rather than a single-cut procedure
Intramedullary rod type, size, and method of passage through humeral shaft segments
Pre-operative imaging confirming deformity or pathology requiring multi-level correction
Operative note documenting realignment achieved and final fixation construct
Diagnosis code mapped to the structural humeral pathology (e.g., osteogenesis imperfecta, post-traumatic malunion)

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 62 Co-surgeons 74 Discontinued post-anesthesia 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 24410 describes a Sofield-type procedure on the humeral shaft: the surgeon makes multiple cuts through a malformed or repeatedly fractured humerus, realigns the resulting segments, and threads an intramedullary rod through them to hold the corrected alignment. This is a reconstructive bone procedure, not a simple single-cut osteotomy — 24400 covers a single humeral osteotomy with or without internal fixation, while 24410 is reserved for cases requiring multiple osteotomies in the same operative session.

The 90-day global period means all routine post-op management, wound checks, and dressing changes are bundled through day 90. Unrelated E/M visits or procedures during that window require modifier 24 or 79, respectively. The significant RVU weight reflects the technical complexity: multiple bone cuts, fragment realignment, and rod passage through the humeral shaft canal all in a single sitting.

This code is used most often in pediatric or young-adult patients with conditions such as osteogenesis imperfecta or severe post-traumatic humeral deformity requiring staged correction. Operative note specificity is critical — the number of osteotomy sites, the indication driving the need for multiple cuts, and rod type/size must all be documented to survive audit.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	14.73
Practice expense RVU	11.39
Malpractice RVU	3.13
Total RVU	29.25
Medicare national rate	$976.98
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	$976.98
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI G2) Ambulatory surgical center (freestanding)	$6,804.43

Common denial reasons

The recurring reasons claims for CPT 24410 get rejected.

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

Operative note documents only a single osteotomy site, supporting 24400 rather than 24410
Medical necessity not established — no pre-op imaging or clinical documentation of deformity requiring multi-level correction
Missing rod type, size, or fixation details in operative report triggers technical insufficiency denial
ICD-10 diagnosis code does not support a reconstructive multi-osteotomy procedure (e.g., routine fracture code used instead of deformity or bone fragility code)
Global period conflict — post-op visits billed without modifier 24 within the 90-day window

Frequently asked questions

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

01What distinguishes 24410 from 24400?

24400 covers a single humeral osteotomy with or without internal fixation. 24410 requires multiple osteotomy cuts along the humeral shaft with realignment maintained by an intramedullary rod — the Sofield technique. If you performed only one cut, bill 24400.

02Can 24410 and 24400 be billed together on the same arm in the same session?

No. 24410 already encompasses multiple osteotomies of the humeral shaft. Billing 24400 alongside it for the same bone in the same session is redundant and will trigger a bundling edit.

03What ICD-10 diagnoses most commonly support 24410?

Osteogenesis imperfecta (Q78.0), humeral malunion (M84.821–M84.829), and post-traumatic deformity codes are the most defensible. A routine closed fracture code alone will not support a multi-osteotomy reconstructive procedure.

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

All routine post-op visits, dressing changes, and stitch removals within 90 days of surgery are bundled. Append modifier 24 to unrelated E/M visits and modifier 79 to unrelated procedures performed during the global period. Modifier 78 applies only if you return to the OR for a complication directly related to the original procedure.

05Is modifier 22 appropriate for an unusually complex Sofield procedure?

Yes, if operative time or difficulty significantly exceeded the typical case — for example, severe cortical thinning requiring additional fixation techniques or an unusually high number of osteotomy segments. Append modifier 22, increase the billed amount, and attach a cover letter with operative note excerpts justifying the additional work. Payer discretion applies.

06Can a co-surgeon or assistant surgeon bill alongside 24410?

A co-surgeon can bill with modifier 62 if two surgeons of different skills each performed distinct portions of the procedure and both document their individual contributions. An assistant surgeon bills with modifier 80 (or AS if a non-physician). Medicare coverage for assistant surgeons on this code should be verified in the PFS indicator data before billing.

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 number of osteotomy sites, the specific segment locations along the humeral shaft, rod specifications, and the clinical indication driving multi-level correction — the exact elements auditors check to distinguish 24410 from the lower-valued single-osteotomy code 24400. Missing any of these details is the primary reason payers downcoded or denied this procedure.

See how Mira captures CPT 24410 documentation