Fracture care · Elbow

24500

Closed treatment of a humeral shaft fracture without manipulation — no incision, no fracture reduction performed.

Verified May 8, 2026 · 6 sources ↓

Medicare
$415.17
Total RVUs
12.43
Global, days
90
Region
Elbow
Drawn from CMSAAPCMdclarityAAOSNIH

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

  • Confirm fracture location in the humeral shaft — not the proximal humerus, distal humerus, or epiphyseal region, which map to different codes.
  • State explicitly that no manipulation was performed and no incision was made.
  • Document immobilization method used: splint, sling, coaptation splint, or functional brace, including application details.
  • Record imaging reviewed (X-ray series, views, findings) and fracture displacement status at time of presentation.
  • Note neurovascular exam findings — radial nerve integrity is particularly relevant for humeral shaft fractures.
  • Document the mechanism of injury and clinical rationale for conservative management without manipulation.

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 25 Significant separate E/M 57 Decision for surgery 58 Staged or related 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 24500 covers closed (non-operative) management of a humeral shaft fracture where the treating physician neither opens the skin nor manually reduces the fracture. The visit typically includes clinical assessment, imaging review, and application of a splint, sling, or functional brace. Because no manipulation is performed, this code sits below 24505, which covers closed treatment with manipulation.

The 90-day global period begins on the date of service. That window includes all routine follow-up visits, splint or brace adjustments, and standard wound or soft-tissue checks related to the fracture. Any E/M service unrelated to the fracture during that 90-day window requires modifier 24. A new, unrelated procedure by the same physician needs modifier 79; an unplanned return to the procedure room for a related complication requires modifier 78.

Side-specific modifiers LT and RT apply when laterality is relevant to payer adjudication. If the clinical complexity substantially exceeds the typical presentation — for example, a pathologic fracture with significant comorbidities requiring extended decision-making — modifier 22 is available, but the operative or clinical note must explicitly document the additional work and time. Per CMS Physician Fee Schedule 2026, HOPD and ASC payment rates differ; see the Site of Service comparison table on this page.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU3.32
Practice expense RVU8.41
Malpractice RVU0.7
Total RVU12.43
Medicare national rate$415.17
Global period90 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

SettingMedicare rate (national)
Office (PFS non-facility)
Procedure performed in physician's office
$415.17
HOPD (APC 5111)
Hospital outpatient department
$252.01
ASC (PI A2)
Ambulatory surgical center (freestanding)
$135.54

Common denial reasons

The recurring reasons claims for CPT 24500 get rejected.

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

  • Fracture site not specified — payer cannot confirm humeral shaft versus proximal or distal humerus codes.
  • No documentation that manipulation was absent, leaving ambiguity about whether 24505 was the appropriate code.
  • E/M billed same-day without modifier 25, or billed during the 90-day global period without modifier 24.
  • Missing laterality modifier (LT/RT) required by specific payers, triggering technical denial.
  • ICD-10 diagnosis code does not match humeral shaft fracture, causing CPT-to-diagnosis mismatch rejection.

Frequently asked questions

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

01What is the difference between CPT 24500 and 24505?
24500 is closed treatment without manipulation — no fracture reduction is performed. 24505 covers closed treatment with manipulation, meaning the physician manually reduces the fracture. The operative or clinical note must state clearly which was done; defaulting to 24500 when reduction was attempted will underbill and may not reflect actual work.
02Can I bill an E/M visit on the same day as 24500?
Yes, if the E/M service is a separately identifiable service beyond the fracture care decision — for example, managing an unrelated problem. Append modifier 25 to the E/M code. If the E/M was solely to evaluate and decide on fracture treatment, it is bundled into 24500.
03What happens if the patient needs manipulation at a follow-up visit during the global period?
If manipulation becomes necessary during the 90-day global, that is a new procedure. Bill 24505 with modifier 58 (staged or related procedure by the same physician during the postoperative period). Modifier 58 resets the global clock. Do not use modifier 78 — that is for unplanned returns for complications, not for an upgraded procedure.
04Is a pathologic humeral shaft fracture billed the same way?
The CPT code is the same (24500 for closed treatment without manipulation), but the ICD-10 diagnosis code changes to reflect the pathologic nature (e.g., M84.52x- series). Payers may scrutinize medical necessity more closely for pathologic fractures. If management complexity substantially exceeds the norm, modifier 22 with supporting documentation is appropriate.
05Does 24500 include the initial casting or splinting?
Yes. Application of the initial cast, splint, or brace is bundled into 24500 per NCCI policy — it cannot be separately reported. Subsequent cast changes or replacement splints during the global period are also included. Separate splinting codes are only billable when no fracture care code is reported.
06Should I use modifier 50 for a bilateral humeral shaft fracture?
Bilateral humeral shaft fractures are rare, but if both sides are treated at the same encounter, modifier 50 applies with a single line item, or LT/RT can be reported on separate lines depending on payer preference. Confirm the payer's bilateral billing policy before submitting — some commercial payers reject modifier 50 on fracture codes and require separate lines.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

  1. 01CMS Physician Fee Schedule 2026
  2. 02
    cms.gov
    https://www.cms.gov/files/document/2026-medicaid-ncci-chapter-4-policy-manual.pdf
  3. 03
    aapc.com
    https://www.aapc.com/codes/cpt-codes/24500
  4. 04
    mdclarity.com
    https://www.mdclarity.com/cpt-code/24500
  5. 05
    aaos.org
    https://www.aaos.org/globalassets/quality-and-practice-resources/coding-and-reimbursement/resident-guide/resident-guide_modifiers.pdf
  6. 06
    vsac.nlm.nih.gov
    https://vsac.nlm.nih.gov/context/cs/codesystem/CPT/version/2021/code/24500/info

Mira AI Scribe

Mira's AI scribe captures fracture location (humeral shaft), confirmation that no manipulation was performed, immobilization type applied, neurovascular exam findings including radial nerve status, and imaging findings from dictation. This prevents the two most common audit flags: ambiguous fracture site documentation and missing confirmation of the no-manipulation criterion that distinguishes 24500 from 24505.

See how Mira captures CPT 24500 documentation

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Percutaneous pin fixation of a non-thumb carpometacarpal dislocation, with closed manipulation, billed per joint treated.
29834 $468.61
Arthroscopic surgical procedure on the elbow involving removal of a loose body or foreign body through the arthroscope, requiring either a separate incision or enlarged portal when the fragment equals or exceeds the cannula diameter.
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