Open repair of humeral nonunion or malunion using an autogenous bone graft harvested from the patient.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $1,004.03
- Total RVUs
- 30.06
- Global, days
- 90
- Region
- Elbow
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 6 cited references ↓
- Pre-operative imaging (X-ray, CT, or MRI) confirming nonunion or malunion of the humerus with radiographic findings documented in the note
- Operative note naming the osteotomy technique performed and the specific site of the nonunion or malunion corrected
- Autograft harvest site identified by anatomic location with graft dimensions or volume recorded
- Fixation method documented (e.g., plate and screws, intramedullary nail, external fixator) with hardware description
- Indication distinguishing nonunion versus malunion — affects ICD-10 code selection and supports medical necessity
- Prior treatment history establishing failed conservative or surgical management, if applicable
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 6 cited references ↓
CPT 24435 covers open surgical correction of a nonunion or malunion of the humerus where the surgeon resects or reshapes the poorly healed bone segment and stabilizes it using bone graft taken from the patient's own body (autograft). The procedure addresses failed primary fracture healing — either a complete failure to unite or a union in a mechanically unacceptable position — and typically involves osteotomy, graft harvest, graft placement, and internal fixation in the same operative session.
This is a high-complexity upper extremity reconstruction carrying a 90-day global period. All routine follow-up, dressing changes, and postoperative management through day 90 are bundled. Anything unrelated to the humeral repair billed in that window requires modifier 24 or 25, and a staged or unplanned return to the OR for a related complication requires modifier 78.
Because autograft harvest is included in the code's work valuation, do not separately bill a bone graft harvest code for the donor site unless a distinct, separately reportable procedure at a remote anatomic site is performed and documented. Audit teams routinely flag 24435 claims where the operative note fails to describe the graft harvest site, graft dimensions, fixation method, or the pre-op imaging confirming nonunion or malunion status.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 14.62 |
| Practice expense RVU | 12.39 |
| Malpractice RVU | 3.05 |
| Total RVU | 30.06 |
| Medicare national rate | $1,004.03 |
| 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 | $1,004.03 |
HOPD (APC 5115) Hospital outpatient department | $13,116.76 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $9,054.40 |
Common denial reasons
The recurring reasons claims for CPT 24435 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Medical necessity not established — no imaging or prior treatment records submitted to confirm failed fracture healing
- Autograft harvest billed separately with a bone graft code when it is already included in 24435's work RVU
- ICD-10 code mismatch — nonunion diagnosis (M84.3xx) submitted with a malunion code (M84.4xx) or vice versa
- Global period conflict — post-op visit or related return-to-OR billed without modifier 78 or 79 within the 90-day window
- Operative note documents 'standard approach' without identifying the specific surgical technique, graft site, or fixation construct
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01Is the bone graft harvest separately billable with 24435?
02What ICD-10 codes pair with 24435?
03Can 24435 be billed with a proximal humerus ORIF code on the same day?
04What modifier applies if the patient needs a return to the OR within the 90-day global for a wound complication at the same site?
05Is 24435 performed bilaterally?
06How does the site of service affect reimbursement for 24435?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02aapc.comhttps://www.aapc.com/codes/cpt-codes/24435
- 03findacode.comhttps://www.findacode.com/cpt/24435-cpt-code.html
- 04mdclarity.comhttps://www.mdclarity.com/cpt-code/24435
- 05cms.govhttps://www.cms.gov/files/document/04-chapter4-ncci-medicare-policy-manual-2026-final.pdf
- 06cgsmedicare.comhttps://www.cgsmedicare.com/medicare_dynamic/j15/partb/ptpb/ptp.aspx
Mira AI Scribe
Mira's AI scribe captures the nonunion or malunion confirmation from dictation (imaging date, side, fracture location), autograft harvest site and graft dimensions, osteotomy technique, fixation hardware, and any intraoperative fluoroscopy use. That prevents the two most common 24435 denials: missing graft harvest documentation that triggers unbundling edits, and vague operative notes that fail medical necessity review.
See how Mira captures CPT 24435 documentation