Percutaneous skeletal fixation of a supracondylar humeral fracture using pins placed through the skin without open incision.

Verified May 8, 2026 · 5 sources ↓

Medicare: $751.85
Total RVUs: 22.51
Global, days: 90
Region: Elbow

Drawn from CMSNIHAAOSCgsmedicareWorkerscomp

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Fracture classification or displacement grade (e.g., Gartland type II or III) justifying operative intervention
Confirmation that closed reduction was attempted and achieved — or that open reduction was NOT required (to distinguish from 24545)
Fluoroscopy findings confirming pin placement and fracture reduction, including number and configuration of pins
Laterality documented explicitly (left vs. right) in operative note and on the claim
Neurovascular status pre- and post-reduction, particularly anterior interosseous nerve and radial pulse
Patient age and weight if pediatric, supporting anesthesia and facility-level documentation
Operative note describing pin entry sites, trajectory, and any intraoperative repositioning attempts

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 50 Bilateral procedure 51 Multiple procedures 57 Decision for surgery 58 Staged or related 62 Co-surgeons 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 5 cited references ↓

CPT 24538 covers closed reduction with percutaneous pin fixation of a supracondylar humerus fracture — the procedure most commonly performed for displaced pediatric supracondylar fractures. The surgeon manipulates the fracture into alignment under fluoroscopic guidance and drives Kirschner wires through the skin to stabilize the distal humerus without an open incision. When open incision is required to achieve reduction, report 24545 instead.

The 90-day global period covers the surgery, all routine post-op visits, hardware monitoring, and pin removal if performed within the global window. Unrelated E/M visits during the global require modifier 24. A separate E/M on the day of surgery requires modifier 25, documented with a distinct medical necessity statement. Fluoroscopic guidance used intraoperatively is generally bundled and not separately reportable.

For bilateral injuries — rare but possible in polytrauma — append modifier 50 and bill once, or bill each side with LT/RT per payer preference. When a second surgeon actively participates in the procedure, modifier 62 applies. Assistant surgeons bill with modifier 80; a PA or NP assisting appends modifier AS.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.53
Practice expense RVU	10.94
Malpractice RVU	2.04
Total RVU	22.51
Medicare national rate	$751.85
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	$751.85
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 24538 get rejected.

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

Laterality missing or mismatched between operative note and claim — payers reject without LT or RT modifier
Upcoding flag when 24545 (open reduction) is billed but operative note describes a closed technique consistent with 24538
Fluoroscopy billed separately when intraoperative imaging is bundled into the surgical code
Separate E/M billed on the day of surgery without modifier 25 and a distinct, documented medical decision
Global period violation — routine post-op visit billed without modifier 24 when the visit is unrelated to the fracture care

Frequently asked questions

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

01What's the difference between 24538 and 24545?

24538 is closed reduction with percutaneous pinning — no incision for fracture access. 24545 is open reduction with percutaneous pinning. If you made an incision to visualize or manipulate the fracture fragments, 24545 is correct. The operative note must clearly state the technique used; auditors look for this distinction first.

02Is fluoroscopy separately billable with 24538?

No. Intraoperative fluoroscopic guidance is considered integral to percutaneous pinning and is bundled into 24538. Billing it separately will trigger an NCCI bundling denial.

03Can I bill pin removal separately after a 24538?

Pin removal within the 90-day global is included — it's part of the global package and not separately billable. If pin removal occurs after the global period ends, report it with the appropriate removal code and document the date of original surgery to establish the timeline.

04How do I bill if a complication requires return to the OR during the global period?

If the return procedure is related to the original fixation (e.g., pin migration requiring repositioning), use modifier 78. If the return is for a completely unrelated condition, use modifier 79. Do not invert these — modifier 78 is for related, modifier 79 is for unrelated.

05Is 24538 ever appropriate for adults, or is this a pediatric-only code?

The code is not age-restricted. Supracondylar fractures occur predominantly in children ages 3–10, but adults with low-energy distal humeral fractures can also be treated with closed reduction and percutaneous pinning. Document the fracture pattern and clinical rationale regardless of patient age.

06What modifier applies when two surgeons each play an active role in the procedure?

Both surgeons append modifier 62 to 24538. Each bills the code independently with modifier 62. The operative note must document the distinct role each surgeon performed — vague co-surgeon notes are a common audit target.

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 type and displacement classification, confirmation of closed reduction technique, pin count and configuration, fluoroscopic reduction confirmation, and neurovascular exam findings pre- and post-op — all from dictation. This prevents the most common audit flag on 24538: an operative note that doesn't explicitly exclude open reduction, which triggers downcoding review against 24545.

See how Mira captures CPT 24538 documentation