Surgical treatment of a humeral shaft fracture using an intramedullary implant (such as a nail or rod), with or without cerclage wiring and/or locking screws.

Verified May 8, 2026 · 5 sources ↓

Medicare: $797.61
Total RVUs: 23.88
Global, days: 90
Region: Shoulder

Drawn from AAPCCMSNIH

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify fracture type (e.g., segmental, comminuted, pathologic) and displacement status to justify IM nailing over closed or plate fixation
Name the implant used (e.g., intramedullary nail/rod, brand if relevant) and document use or non-use of cerclage wiring and locking screws
Document the surgical approach by name (e.g., antegrade via anterolateral acromion, retrograde) — notes that just say 'standard approach' flag on audit
Record intraoperative fluoroscopy use for entry point preparation and fracture reduction confirmation
Document any associated injuries (nerve, tendon, muscle) and whether they were repaired separately during the same operative session
If manipulation was performed to achieve reduction, state it explicitly — coders cannot infer manipulation from X-ray findings alone

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 51 Multiple procedures 57 Decision for surgery 58 Staged or related 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 24516 covers intramedullary (IM) nailing of humeral shaft fractures — a technique where a rod is inserted into the medullary canal of the humerus and secured with locking screws, with or without cerclage wiring. This fixation method is the go-to choice for segmental fractures, pathologic fractures, and patients with severe osteoporotic bone where the fracture won't maintain reduction without internal reinforcement. The surgeon may approach antegrade (through the proximal humerus near the acromion, splitting the deltoid and incising the supraspinatus) or retrograde; document the approach explicitly.

This is not a high-volume code — most humeral shaft fractures are managed with closed methods or plate fixation — but it's the correct code when the operative note specifies an intramedullary implant. Don't report 24516 for plate-and-screw open reduction (that's 24515) or for closed treatment with or without manipulation. Separately reportable services may include open fracture debridement, nerve repair, or tendon repair if documented as distinct from the fracture fixation itself. Check contractual bundling before billing those add-ons.

The 90-day global period covers all routine post-op visits, dressing changes, and implant-related follow-up through day 90. An E/M billed the day before or the day of surgery for decision-making requires modifier 57. Unrelated procedures during the global period require modifier 79; a related unplanned return to the OR requires modifier 78.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	11.89
Practice expense RVU	9.49
Malpractice RVU	2.5
Total RVU	23.88
Medicare national rate	$797.61
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	$797.61
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$8,962.97

Common denial reasons

The recurring reasons claims for CPT 24516 get rejected.

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

Wrong code selected — 24515 (plate/screw ORIF) billed when IM implant was used, or vice versa, triggering clinical mismatch on audit
Modifier 57 missing when a same-day or day-before E/M service for surgical decision-making is billed alongside 24516
Separately billed nerve or tendon repair denied as bundled — payer contractual bundling edits vary; confirm coverage before billing add-ons
Global period violation — post-op visits billed without modifier 24 (unrelated) or 79 (unrelated procedure) within the 90-day window
ICD-10 diagnosis code doesn't support IM nailing — e.g., a non-displaced simple shaft fracture coded without documented clinical rationale for implant fixation

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What's the difference between 24515 and 24516?

24515 is for open reduction with plate and/or screws. 24516 is specifically for treatment with an intramedullary implant (nail or rod), with or without cerclage and locking screws. The operative note must specify which fixation construct was used — these codes are not interchangeable.

02Can I bill a separate E/M on the day of surgery if I saw the patient in the ED or office first?

Yes, if the E/M was a significant, separately identifiable service and represented the decision to operate. Append modifier 57 to the E/M code. Without modifier 57, the E/M will deny as included in the surgical package.

03If the patient returns within 90 days for hardware removal or revision, how do I code that?

If the return is a planned, unrelated procedure, use modifier 79. If it's an unplanned return to the OR for a complication related to the original fixation, use modifier 78. Inverting these modifiers is a common and auditable error.

04Is fluoroscopy separately billable with 24516?

Generally no. Intraoperative fluoroscopy used for fracture reduction and nail insertion is considered integral to the procedure. Separately billing 76000 with 24516 risks an NCCI bundling denial.

05When is modifier 22 appropriate with 24516?

Use modifier 22 when the procedure is substantially more complex than typical — for example, a severely comminuted segmental fracture with significant additional operative time and effort. You must document in the operative note why the work exceeded the standard, and attach a cover letter to the claim explaining the increased complexity.

06Can nerve repair or tendon repair be billed separately on the same day?

Yes, if the operative note documents the repair as a distinct service separate from the fracture fixation. However, payer contracts vary — some bundle these services. Verify your specific payer's policy before appending modifier 59 or XS and billing the additional code.

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 implant type and name, locking screw and cerclage details, surgical approach by anatomic name, intraoperative fluoroscopy use, fracture pattern description, and any separately addressed injuries (nerve, tendon, muscle) from the surgeon's dictation. That prevents the most common audit flag on 24516: an operative note that names a fixation implant but omits approach, cerclage status, or locking screw configuration — gaps that reviewers use to downcode or deny.

See how Mira captures CPT 24516 documentation