Surgical arrest of asymmetric physeal growth at the distal humerus using hardware (staple or plate) to correct angular deformity such as cubitus varus or valgus.

Verified May 8, 2026 · 6 sources ↓

Medicare: $638.63
Total RVUs: 19.12
Global, days: 90
Region: Elbow

Drawn from CMSAAPCEmednyAcgmeCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Skeletal age (bone age radiograph) documented preoperatively to confirm adequate remaining growth
Preoperative angular deformity measurement (carrying angle) with comparison to contralateral side
Operative note specifies hardware type (staple vs. plate), exact physeal location, and fluoroscopic confirmation of placement
Diagnosis documented as cubitus varus, cubitus valgus, or specific underlying etiology (e.g., malunion sequela) with corresponding ICD-10 code
If concurrent osteotomy performed, separate documentation of that procedure's indication and technique to support additional code reporting
Patient age and growth remaining assessment supporting clinical decision to use hemiepiphyseal arrest rather than immediate osteotomy

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 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 24470 describes hemiepiphyseal arrest at the distal humerus — a pediatric procedure that selectively tethers one side of the growth plate to redirect bone growth and correct angular deformity. The classic indications are cubitus varus and cubitus valgus, typically from a malunited supracondylar fracture or idiopathic growth disturbance. The surgeon places a staple, plate, or other hardware across the open physis on the overgrown side; controlled compression slows growth on that side while the opposite side catches up, gradually correcting the carrying angle over months to years.

This is almost exclusively a pediatric case. The procedure requires an open incision with fluoroscopic confirmation of hardware position across the physis. Timing is critical — the patient must have sufficient remaining growth for the correction to occur, making preoperative skeletal age documentation essential. Surgeons sometimes perform simultaneous osteotomy (e.g., 24400) for immediate angular correction when remaining growth is insufficient to complete correction alone; if both are performed, modifier 51 applies to the secondary procedure.

The 90-day global period covers all routine post-op visits through day 90, including hardware checks and wound care. Hardware removal — which is planned once correction is achieved — falls outside the global only if performed after day 90 or with modifier 79 if unrelated circumstances require earlier removal. If removal is performed within the global for clinical reasons related to the original procedure, it is bundled unless a distinct unrelated diagnosis drives it.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.71
Practice expense RVU	8.56
Malpractice RVU	1.85
Total RVU	19.12
Medicare national rate	$638.63
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	$638.63
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 24470 get rejected.

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

Lack of skeletal age documentation — payers require evidence of open physis to justify the procedure
Bundling of simultaneous osteotomy (24400) without modifier 51, resulting in the secondary procedure being denied
ICD-10 mismatch — billing a deformity code that does not align with the distal humerus site or the specific varus/valgus diagnosis
Medical necessity denial when the operative note fails to quantify the angular deformity or demonstrate failed conservative management
Hardware removal billed within the 90-day global without modifier 79 when removal is unrelated, or without adequate documentation that removal is clinically distinct

Frequently asked questions

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

01Can 24470 be billed bilaterally?

Bilateral hemiepiphyseal arrest at both elbows in the same session is rare but reportable. Check the bilateral surgery indicator in the Medicare Physician Fee Schedule Database for 24470 before appending modifier 50. Document separate clinical indications for each elbow.

02Is hardware removal after hemiepiphyseal arrest separately billable?

If removal occurs after the 90-day global period, bill the appropriate removal code without a modifier. If it occurs within the global and is planned as part of the original treatment plan (i.e., once correction is achieved), it is bundled. Use modifier 79 only if removal is for a reason genuinely unrelated to the original procedure.

03Can 24470 and 24400 (osteotomy, humerus) be billed together?

Yes, when both procedures are clinically indicated and distinctly performed. Append modifier 51 to the lower-value code. The operative note must document separate indications — typically the osteotomy for immediate correction and the arrest for ongoing growth guidance.

04What ICD-10 codes pair with 24470?

Common pairings include M21.121 (varus deformity, elbow), M21.021 (valgus deformity, elbow), and sequela codes for malunited supracondylar fracture (S42.4x1S range). The laterality suffix must match the operative side documented in the record.

05Does the 90-day global include follow-up imaging to assess correction progress?

Routine radiographs to monitor correction progress are bundled in the 90-day global. If imaging is ordered for a new problem or complication unrelated to the arrest, bill with modifier 24 on the associated E/M. The imaging itself is separately billable regardless of global status.

06Is 24470 appropriate for adults?

No. The physeal arrest mechanism requires an open growth plate. Performing this procedure in a skeletally mature patient has no biological rationale and will not survive medical necessity review. Adult angular correction at the elbow is addressed with osteotomy codes.

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 hardware type and physeal location from dictation, the measured carrying angle pre- and intraoperatively, fluoroscopic confirmation language, and the surgeon's assessment of remaining skeletal growth. That specificity prevents the two most common audit flags for 24470: operative notes that omit hardware placement details and records that lack quantified deformity measurement, both of which draw medical necessity denials.

See how Mira captures CPT 24470 documentation