Prophylactic treatment of the humerus to prevent impending pathologic fracture, with or without methylmethacrylate bone cement reinforcement.

Verified May 8, 2026 · 7 sources ↓

Medicare: $802.29
Total RVUs: 24.02
Global, days: 90
Region: Elbow

Drawn from CMSFastrvuFindacodeAAPC

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Preoperative imaging (X-ray, CT, or MRI) identifying the lesion, cortical involvement, and estimated fracture risk — Mirels score or equivalent clinical criteria support medical necessity.
Operative note specifying fixation device type (intramedullary nail, plate, pins) and whether methylmethacrylate cement was used and injected.
Pathologic diagnosis or biopsy result linking the underlying condition (metastasis, primary tumor, severe osteoporosis) to the treated humeral segment.
Documentation that the humerus had not yet fractured at the time of surgery — prophylactic intent must be explicit and distinguishable from acute fracture treatment.
Laterality documented (left vs. right humerus) to support LT/RT modifier assignment and prevent claim rejection.
Post-op plan noting weight-bearing restrictions and anticipated rehabilitation, consistent with a 90-day global period.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services LT Left side RT Right side 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 24498 covers surgical reinforcement of a structurally compromised humerus at risk for pathologic fracture — most commonly due to metastatic disease, primary bone tumor, or severe osteoporosis. The surgeon stabilizes the weakened segment using internal fixation devices (intramedullary nail, plate, or similar implant), with or without injection of methylmethacrylate cement to fill cortical defects and restore mechanical integrity. The goal is fracture prevention, distinguishing this code from fracture treatment codes in the 24500–24587 range.

The 90-day global period means all routine post-op care through day 90 is bundled. Anything unrelated to the humerus reinforcement billed in that window requires modifier 24 (E/M) or 79 (unrelated procedure). If the patient returns to the OR for a complication directly tied to this procedure, bill modifier 78.

Case selection documentation is critical. Payers scrutinize whether the bone was truly at impending-fracture risk at the time of surgery — not already fractured. Operative notes should confirm preoperative imaging findings, lesion size, cortical involvement, and the clinical decision-making that drove prophylactic rather than acute fracture intervention.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	11.97
Practice expense RVU	9.53
Malpractice RVU	2.52
Total RVU	24.02
Medicare national rate	$802.29
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	$802.29
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$8,923.12

Common denial reasons

The recurring reasons claims for CPT 24498 get rejected.

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

Medical necessity not established — payer finds insufficient documentation that fracture was impending rather than already present, triggering reclassification to a fracture treatment code.
Missing or ambiguous laterality — claim submitted without LT or RT modifier, causing processing rejection or payer-side correction.
Methylmethacrylate billed as a separate supply line without confirming payer policy on implant pass-through; some payers bundle it into the surgical fee.
Global period violations — E/M or procedure billed within the 90-day window without modifier 24 or 79, resulting in automatic denial.
Diagnosis-procedure mismatch — ICD-10 code reflecting an acute pathologic fracture rather than impending fracture undermines prophylactic code selection.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01How do I distinguish 24498 from humeral fracture treatment codes like 24515 or 24516?

24498 is for prophylactic reinforcement of a humerus at risk — the bone has not yet fractured. If the patient presents with an acute pathologic fracture, you're in the 24500s range. Operative and imaging documentation must confirm the bone was intact at the time of surgery.

02Is methylmethacrylate separately billable when used with 24498?

It depends on the payer. Medicare generally bundles cement into the surgical fee; some commercial payers allow a separate supply code. Verify payer-specific implant billing policy before submitting a separate line.

03Can I bill 24498 bilaterally in one session?

Yes. Append modifier 50 for bilateral same-session prophylactic reinforcement, or use LT and RT on separate lines depending on payer preference. Confirm which format your payer accepts before submitting.

04What ICD-10 codes best support 24498?

Codes reflecting neoplastic bone involvement (e.g., C79.82 for secondary malignant neoplasm of bone) or pathologic fracture risk without completed fracture (M84.52x series for pathologic fracture risk, humerus) are the strongest match. Avoid acute fracture codes — they contradict prophylactic intent.

05What happens if the patient returns to the OR within the 90-day global for a related complication?

Bill the return procedure with modifier 78 (unplanned return for a related procedure during the postoperative period). Do not use modifier 79 — that is reserved for unrelated procedures during the global period.

06Does 24498 require assistant surgeon documentation?

If an assistant surgeon or qualified non-physician practitioner assists, bill modifier 80 or AS respectively. Document the medical necessity for assistance in the operative note — some payers require it explicitly for reimbursement of assistant surgeon fees.

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 surgeon's dictated rationale for prophylactic intent — lesion size, cortical involvement percentage, imaging findings, and Mirels score or equivalent risk assessment — along with the specific fixation construct used and whether methylmethacrylate was injected. That detail prevents the most common denial: a payer reclassifying 24498 as an acute fracture treatment code because the operative note didn't clearly establish pre-fracture status.

See how Mira captures CPT 24498 documentation