Open treatment of a distal humeral fracture that extends into the intercondylar region, requiring fixation of both the supracondylar and intraarticular components.

Verified May 8, 2026 · 6 sources ↓

Medicare: $953.60
Total RVUs: 28.55
Global, days: 90
Region: Elbow

Drawn from CMSAAPCAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Fracture pattern must be explicitly documented as having intercondylar extension — 'T-type,' 'Y-type,' or 'bicolumnar' are acceptable descriptors; 'distal humerus fracture' alone is insufficient.
Operative note must identify the surgical approach by name (e.g., olecranon osteotomy, triceps-reflecting, paratricipital) — notes that say 'standard posterior approach' are audit flags.
Fixation construct must be described in detail, including implant type, configuration (dual-column plating, crossed screws, etc.), and anatomic placement.
Ulnar nerve handling must be documented — whether identified only, released, or formally transposed — to support or refute separate billing of 64718.
Intraoperative fluoroscopy findings should be recorded if used for fracture reduction verification; fluoroscopy is bundled into 24546 and cannot be billed separately.
Pre-op imaging (CT preferred for comminuted patterns) should be referenced in the operative note to establish fracture classification and surgical planning rationale.
Laterality must be specified (left or right) for proper modifier assignment.

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 59 Distinct service 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 XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 24546 covers open reduction and internal fixation of a distal humeral fracture with intercondylar extension — the classic 'T' or 'Y' pattern fracture that splits the condyles apart while also breaking the shaft-to-condyle junction. This is a technically demanding procedure: the surgeon must reconstruct the articular surface, reduce the intercondylar split, and stabilize the supracondylar component, typically with dual-column plating. The ulnar nerve is routinely identified and often transposed during exposure, which is a key bundling consideration.

This code differs from 24545 specifically because of the intercondylar extension. If the fracture is purely supracondylar or transcondylar without articular involvement, 24545 applies. Coding 24546 for a fracture that lacks documented intraarticular extension is a common audit target. The 90-day global period covers all routine post-op care through day 90; any unrelated E/M service in that window needs modifier 24.

Ulnar nerve transposition (64718) is frequently performed alongside 24546 but is considered bundled under NCCI edits because ulnar nerve management is inherent to the surgical approach. Billing 64718 separately triggers CCI edit conflicts unless documentation clearly supports a distinct, separately reportable nerve procedure — and even then, payer acceptance varies. Confirm with your MAC before appending modifier 59 or XS.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	14.54
Practice expense RVU	11.01
Malpractice RVU	3
Total RVU	28.55
Medicare national rate	$953.60
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	$953.60
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$9,148.76

Common denial reasons

The recurring reasons claims for CPT 24546 get rejected.

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

Upcoding denial when operative note documents only a supracondylar fracture pattern without confirming intercondylar articular involvement — 24545 would be correct in that scenario.
NCCI bundling denial when 64718 (ulnar nerve transposition) is billed alongside 24546 without a modifier and without documentation supporting a separately distinct nerve procedure.
Global period denial for post-op E/M services billed without modifier 24 when the visit is routine fracture follow-up within the 90-day window.
Laterality error denial when LT or RT modifier is missing or mismatched with the operative report.
Medical necessity denial when pre-authorization was obtained for a closed treatment code and the procedure was subsequently performed open without updated authorization.

Frequently asked questions

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

01What separates 24546 from 24545?

The intercondylar extension. CPT 24545 covers open treatment of supracondylar and transcondylar fractures without articular involvement. Once the fracture line splits into the condyles — creating the classic T or Y pattern — 24546 is correct. The distinction must be documented in the operative note and supported by pre-op imaging.

02Can I bill 64718 for ulnar nerve transposition performed during 24546?

Generally no. NCCI edits bundle 64718 into 24546 because ulnar nerve identification and management is inherent to the posterior surgical approach. The coding community forum consensus is that a modifier alone is usually insufficient — you need documentation showing the nerve work was a distinct, separately indicated procedure. Confirm with your MAC before billing both.

03What modifier applies if I operate on the wrong side by documentation error — or need to bill a bilateral case?

Bilateral distal humeral intercondylar fractures are exceedingly rare, but if legitimately bilateral, bill with modifier 50 on a single line or LT/RT on separate lines per payer preference. For unilateral cases, always append LT or RT. Modifier 50 without payer-specific guidance often triggers manual review.

04A co-surgeon assists with the reconstruction. How do I bill that?

When two surgeons of different specialties each perform distinct portions of the procedure (e.g., orthopedic surgeon and a hand surgeon managing nerve work), both may bill 24546 with modifier 62. If one surgeon assists only, the assistant bills with modifier 80 (MD) or AS (PA/NP/CRNA). Document each surgeon's distinct contribution in the operative note.

05The fracture was more complex than typical — significant comminution required extra time and implants. Can I use modifier 22?

Yes, if the work substantially exceeded what 24546 normally entails. Document specifically: degree of comminution, number of fragments, extra operative time, and why the complexity was unusual. A cover letter or addendum explaining the increased work is essential — modifier 22 without supporting documentation is routinely denied or ignored by payers.

06What ICD-10 codes pair with 24546?

The S42.4x series covers distal humeral fractures. For intercondylar fractures specifically, look to S42.44 (lateral condyle), S42.45 (medial condyle), and S42.40 (unspecified condyle) with appropriate 7th character for encounter type (A for initial, D for subsequent, S for sequela). CT-confirmed fracture classification in the chart supports the specificity required.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures fracture pattern classification (intercondylar extension, T-type, Y-type, bicolumnar), surgical approach by name, fixation construct details, and ulnar nerve management from dictation. This prevents the most common 24546 audit trigger — operative notes that don't explicitly confirm intraarticular extension — and flags when ulnar nerve transposition language could inadvertently support a bundled 64718 claim.

See how Mira captures CPT 24546 documentation