Open repair of a nonunion or malunion of the humeral shaft without bone graft augmentation.

Verified May 8, 2026 · 5 sources ↓

Medicare: $969.63
Total RVUs: 29.03
Global, days: 90
Region: Other

Drawn from CMSCgsmedicareAAOS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Confirm nonunion or malunion diagnosis with imaging (X-ray, CT) and note prior fracture history and treatment timeline
Operative note must specify that no bone graft was harvested or applied — absence of graft is what distinguishes 24430 from 24435
Document the fixation construct used (plate, nail, screws) and the intraoperative findings at the nonunion or malunion site
Record the surgical approach by name and confirm it is an open procedure, not percutaneous or arthroscopic
Note any comorbidities affecting healing (e.g., diabetes, tobacco use, metabolic bone disease) that support medical necessity
Include preoperative neurovascular exam findings given radial nerve proximity to humeral shaft

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 52 Reduced services 58 Staged or related 59 Distinct service 62 Co-surgeons 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 5 cited references ↓

CPT 24430 covers open surgical correction of a failed or malpositioned humeral shaft fracture — specifically nonunion (fracture that never healed) or malunion (fracture that healed in poor alignment) — when the surgeon does not use a bone graft as part of the repair. The procedure typically involves rigid internal fixation, debridement of the nonunion site, and correction of alignment, all without harvesting or applying supplemental bone graft material. That distinction is critical: if autograft or allograft is used, 24435 is the correct code.

The 90-day global period covers the surgery date, the day-before visit, and all routine postoperative management through day 90. Fracture nonunion repairs carry complexity that auditors scrutinize — document the prior fracture history, previous treatment, and the specific reason graft was not required. If a separate, unrelated E/M occurs in the global window, append modifier 24. A staged or planned return to add bone graft within the global period uses modifier 58.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	14.87
Practice expense RVU	11.1
Malpractice RVU	3.06
Total RVU	29.03
Medicare national rate	$969.63
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	$969.63
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$8,966.49

Common denial reasons

The recurring reasons claims for CPT 24430 get rejected.

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

Upcoding flag when bone graft is documented intraoperatively but 24430 (no graft) is billed instead of 24435
Medical necessity denial when imaging or clinical notes fail to clearly establish nonunion or malunion diagnosis prior to surgery
Global period bundling: postoperative E/M visits billed without modifier 24 when unrelated to the surgery are denied
Missing laterality documentation causes payer edits — append LT or RT and confirm the operative note matches
Insufficient prior treatment history to justify nonunion repair; payers expect documentation showing conservative or prior surgical management

Frequently asked questions

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

01What is the difference between CPT 24430 and 24435?

24430 is humeral nonunion or malunion repair without bone graft. 24435 is the same procedure with bone graft. If any autograft or allograft is placed at the repair site, bill 24435. The distinction must be explicit in the operative note — do not leave auditors to infer it.

02Can I bill a separate code for internal fixation hardware when reporting 24430?

No. Rigid internal fixation (plates, screws, intramedullary nail) is integral to the nonunion repair and is bundled into 24430. Separately billing fixation codes will trigger an NCCI PTP bundling denial.

03What global period applies to 24430 and what does it cover?

24430 carries a 90-day global period. It includes the surgery day, the day-before preoperative visit, and all routine postoperative management through day 90. Unrelated E/M visits in that window need modifier 24; a staged return to add bone graft needs modifier 58.

04Is modifier 22 ever appropriate for 24430?

Yes, when the procedure is substantially more work than typical — for example, a revision after prior failed fixation with hardware removal, extensive scar debridement, or significant deformity correction. Document increased time and complexity in the operative note and attach a cover letter to the claim.

05How should bilateral humeral nonunion repairs be billed?

Bilateral humeral nonunion repair is exceedingly rare, but if performed on the same day, bill each side on a separate claim line with modifiers LT and RT. In an ASC setting, this is the standard bilateral reporting method per CMS NCCI policy.

06What ICD-10 codes support medical necessity for 24430?

Use M84.32x (stress fracture, humerus — though less common), or more typically M84.82x (nonunion of fracture, humerus) and M84.42x (pathological fracture in neoplastic disease if applicable). Malunion maps to M84.02x. Confirm laterality with the appropriate 7th character.

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 nonunion or malunion diagnosis from dictation, the named surgical approach, fixation hardware used, explicit confirmation that no bone graft was placed, and preoperative imaging correlation. This prevents the most common audit flag for 24430: an operative note that mentions graft preparation or application without clarifying it was ultimately not used — a discrepancy that triggers a 24430-to-24435 upcoding review.

See how Mira captures CPT 24430 documentation