Closed treatment of a supracondylar or transcondylar humeral fracture, with manipulation, including cases with intercondylar extension

Verified May 8, 2026 · 5 sources ↓

Medicare: $690.06
Total RVUs: 20.66
Global, days: 90
Region: Elbow

Drawn from CMSFindacodeAAOSEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Confirm treatment remained closed — no percutaneous pins, no open incision
Document that manipulation was performed; absence of this detail downcodes to 24530
Specify fracture pattern: supracondylar, transcondylar, or intercondylar extension present
Record neurovascular status before and after reduction (anterior interosseous nerve, radial pulse)
Document imaging confirming fracture type, displacement, and post-reduction alignment
Note anesthesia type used for reduction (conscious sedation, general, hematoma block)
Specify immobilization applied after reduction (posterior splint, long arm cast, position of elbow)

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 52 Reduced services 57 Decision for surgery 58 Staged or related 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 24535 covers closed (non-operative) reduction of a supracondylar or transcondylar distal humeral fracture where manipulation is required. This distinguishes it from 24530, which covers closed treatment without manipulation. Intercondylar extension — when the fracture line splits into the joint — does not change the code as long as the treatment remains closed. The code carries a 90-day global period, so all routine post-reduction management, cast or splint changes, and follow-up visits through day 90 are bundled.

This fracture pattern is most common in the pediatric population after a fall on an outstretched hand, but 24535 applies regardless of patient age. When closed reduction fails and pins are required percutaneously, that work escalates to 24538. If open reduction becomes necessary, codes in the 24545–24546 range apply. Choosing the wrong code in the series is the most common audit flag here — documentation must confirm the treatment remained closed throughout.

The 90-day global means a decision-for-surgery E/M on the day of or day before the manipulation needs modifier 57 to be separately payable. Any unrelated E/M during the global period requires modifier 24. A staged or related return procedure by the same surgeon during the global (e.g., planned conversion to ORIF) uses modifier 58 and resets the global clock.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.93
Practice expense RVU	12.26
Malpractice RVU	1.47
Total RVU	20.66
Medicare national rate	$690.06
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	$690.06
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 24535 get rejected.

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

Code billed as 24535 but operative note describes percutaneous pinning — should be 24538
Lack of documentation confirming manipulation was performed, triggering downcode to 24530
E/M billed same day without modifier 25 (if unrelated) or modifier 57 (if decision for surgery on a major procedure)
Post-reduction visit billed within 90-day global without modifier 24 for an unrelated condition
ICD-10 fracture code does not specify laterality or matches a pattern inconsistent with supracondylar/transcondylar anatomy

Frequently asked questions

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

01What's the difference between 24530 and 24535?

24530 is closed treatment without manipulation. 24535 requires documentation that manipulation was performed. If your note doesn't explicitly state that reduction was carried out, payers will downcode to 24530.

02Can I bill 24535 if the fracture has intercondylar extension?

Yes. Intercondylar extension is included within 24535 as long as treatment remains closed with manipulation. The fracture complexity alone doesn't change the code.

03What code do I use if I add percutaneous pins during the same session?

Escalate to 24538 (closed treatment with percutaneous pinning). 24535 is strictly non-pin, closed management.

04How do I bill an E/M on the same day I perform the manipulation?

If you're making the decision for surgery (manipulation under anesthesia) at an E/M that same day or the day before, append modifier 57 to the E/M. If the E/M addresses a truly separate problem, use modifier 25.

05Does the 90-day global cover follow-up cast changes and X-rays?

Routine post-reduction office visits and dressing or splint changes are bundled. Separately ordered X-rays (supervision and interpretation) are not globally bundled and may be billed with modifier 26 if you're providing only the professional component.

06If closed reduction fails and I convert to ORIF during the same global period, which modifier applies?

Use modifier 58 if conversion to open treatment was staged or planned. Use modifier 78 only for an unplanned return to the OR for a complication related to the original procedure. Modifier 79 is for an unrelated procedure in the global window.

07Is modifier 50 appropriate for bilateral supracondylar fractures?

Bilateral supracondylar fractures are rare but modifier 50 is correct if both sides are treated at the same session. LT and RT on separate lines is the alternative — confirm your payer's preference, as some require 50 and others prefer LT/RT.

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 pattern (supracondylar, transcondylar, intercondylar extension), confirmation that treatment remained closed, performance of manipulation, pre- and post-reduction neurovascular exam findings, imaging results, anesthesia method, and post-reduction immobilization details. This prevents the most common denial — a note that omits explicit confirmation of manipulation and triggers an automatic downcode to 24530.

See how Mira captures CPT 24535 documentation