Closed treatment of a medial or lateral humeral epicondylar fracture without manipulation — no surgical incision, no reduction performed.

Verified May 8, 2026 · 6 sources ↓

Medicare: $390.79
Work RVU: 2.91
Global, days: 90
Region: Elbow

Drawn from NIHAAPCFindacodeFastrvuDam

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Explicit fracture diagnosis confirmed in the note — 'suspected fracture' is insufficient to support 24560
Specify medial or lateral epicondyle as the fracture site
Imaging report (X-ray or CT) corroborating the fracture, referenced or attached to the encounter note
Document that no manipulation was performed and that closed management (splinting, casting, or bracing) was chosen
Record the immobilization method applied and instructions provided to the patient
Document the initiating provider as the fracture care provider if global period billing will follow

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 6 cited references ↓

CPT 24560 covers the closed, non-manipulative management of a humeral epicondyle fracture, either medial or lateral. The provider diagnoses the fracture, typically via imaging, and manages it with splinting, casting, or bracing — but does not physically reduce or reposition the fragment. No operative procedure is performed; this is fracture care built around immobilization and follow-up.

The 90-day global period starts on the date of service. That window covers all routine follow-up visits, cast or splint changes, and associated E/M services related to the fracture. Billing a separate office visit for fracture-related care during the global requires modifier 24. An unrelated procedure during the global period needs modifier 79.

Documentation must confirm a confirmed fracture diagnosis — not just elbow pain or suspicion of fracture. AAPC forum discussions on this code consistently flag denials where the note lacks an explicit fracture diagnosis before billing 24560. The treating physician must also be the one initiating fracture care; if another provider takes over management, the global period and billing attribution require careful coordination.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (2.91) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (11.7) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.91
Practice expense RVU	8.17
Malpractice RVU	0.62
Total RVU	11.7
Medicare national rate	$390.79
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	$390.79
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI A2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 24560 get rejected.

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

Fracture not explicitly diagnosed in the note — documentation only describes elbow pain or tenderness without confirmed fracture
No fracture care service documented; provider uses 24560 but note reads as an E/M visit without fracture management
Separate E/M billed during the 90-day global for fracture-related follow-up without modifier 24
Bilateral modifier 50 applied incorrectly — epicondylar fractures are site-specific; both sides require separate ICD-10 laterality codes and clinical justification
Code selected when manipulation was actually performed — those cases require 24565 instead of 24560

Frequently asked questions

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

01Does 24560 require a procedure note?

No separate operative note is required because no manipulation is performed. However, the encounter note must document a confirmed fracture diagnosis, the decision for closed non-manipulative treatment, and the immobilization method. Without a confirmed fracture in the note, the claim will not hold up to audit.

02When should I use 24565 instead of 24560?

Use 24565 when the provider physically manipulates or reduces the epicondylar fracture fragment. If the fragment was repositioned — even without a formal open procedure — that is manipulation and 24560 is the wrong code.

03Can I bill an E/M on the same day as 24560?

Yes, if a separately identifiable evaluation and management service was performed — for example, evaluating an unrelated condition — append modifier 25 to the E/M. If the E/M is for the fracture itself, it is bundled into 24560 and should not be billed separately.

04How does the 90-day global period affect follow-up billing?

All routine fracture-related follow-up visits, cast changes, and splint adjustments within 90 days are included in 24560's global payment. To bill a follow-up E/M for an unrelated problem during that window, append modifier 24 to the E/M code.

05Should I use LT or RT with 24560?

Yes. Append LT or RT to identify the treated side. Pair it with the corresponding ICD-10 laterality code. Medicare and most commercial payers require side-specific reporting for elbow fracture codes.

06Can 24560 be billed for a pediatric epicondyle fracture?

Yes, the code applies to both adult and pediatric patients. The epicondylar apophysis in pediatric patients is a common fracture site; document age, fracture site, and the non-manipulative management plan clearly, as pediatric fracture patterns are a frequent audit focus.

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 confirmed fracture site (medial vs. lateral epicondyle), the absence of manipulation, and the immobilization method from the provider's dictation. It flags encounters where fracture diagnosis language is missing or ambiguous before the claim is submitted — preventing the most common 24560 denial: billing fracture care when the note only documents evaluation without a confirmed fracture.

See how Mira captures CPT 24560 documentation