Open surgical repair of a humeral shaft fracture using plate and screw fixation, with or without cerclage wire.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $822.33
- Total RVUs
- 24.62
- 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 5 cited references ↓
- Operative note must explicitly state 'humeral shaft' as the fracture location — proximal and distal humerus map to different codes
- Fixation method must be documented as plate and screws; intramedullary nail use disqualifies 24515
- Cerclage wire use, if applicable, should be noted (included in 24515; not separately billable)
- Fracture classification and displacement status to support medical necessity
- Laterality (left vs. right) documented in both the operative note and on the claim
- Imaging confirming humeral shaft fracture location and alignment pre- and post-fixation
- If modifier 22 is used, document specific factors increasing complexity: comminution degree, prior hardware, body habitus, or prolonged operative time with explanation
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 5 cited references ↓
CPT 24515 covers open treatment of a humeral shaft fracture secured with a plate-and-screw construct, with or without cerclage. This is diaphyseal fixation — not proximal humerus (23615/23616) and not distal humerus (24545/24546). If the surgeon uses an intramedullary nail instead of a plate, 24515 does not apply; nail fixation of the humeral shaft maps to a different code. The plate-or-nail distinction is a frequent coding error and a reliable audit trigger.
The 90-day global period covers the operative day, the day-before visit, and all routine postoperative management through day 90. Any E/M for an unrelated condition billed inside that window needs modifier 24. A return to the OR for a related complication — hardware failure, wound dehiscence, infection requiring washout — uses modifier 78. An unrelated procedure by the same surgeon in the global period uses modifier 79. Assistant surgeon services bill under modifier 80; PA/NP assistants use AS.
Site of service matters here. The spread between HOPD and ASC payment is substantial — see the Site of Service comparison on this page. Most humeral shaft ORIF in adults is performed in a hospital setting given patient age, comorbidity profile, and anesthesia requirements, but ASC billing is valid when criteria are met.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 11.82 |
| Practice expense RVU | 10.33 |
| Malpractice RVU | 2.47 |
| Total RVU | 24.62 |
| Medicare national rate | $822.33 |
| 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 | $822.33 |
HOPD (APC 5115) Hospital outpatient department | $13,116.76 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $8,818.21 |
Common denial reasons
The recurring reasons claims for CPT 24515 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Wrong anatomic level — proximal humerus fractures coded as 24515 instead of 23615/23616
- Intramedullary nail used but 24515 billed; payers flag the discrepancy against operative implant records
- Missing or ambiguous laterality modifier (LT/RT) causing claim rejection
- E/M billed same-day without modifier 25 when the visit led directly to the surgical decision
- Modifier 78 and 79 inverted on return-to-OR claims during the 90-day global period
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01Can I bill 24515 for an intramedullary nail of the humeral shaft?
02What is the global period for 24515, and what does it include?
03How do I distinguish 24515 from 23615 or 24545?
04If the surgeon returns to the OR for hardware failure during the 90-day global, which modifier applies?
05Can cerclage wire be billed separately alongside 24515?
06When is modifier 22 appropriate with 24515?
07Does the site of service affect reimbursement for 24515?
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 fracture location (humeral shaft vs. proximal or distal), fixation method (plate and screws, cerclage use), laterality, and any complexity factors such as comminution grade or prior hardware from the surgeon's dictation. This prevents the most common 24515 denial: billing plate fixation when implant records reflect an IM nail, or miscoding the anatomic level as proximal humerus.
See how Mira captures CPT 24515 documentation