Closed treatment of a humeral epicondylar fracture with elbow manipulation under anesthesia or manual reduction requiring joint manipulation

Verified May 8, 2026 · 6 sources ↓

Medicare: $601.55
Total RVUs: 18.01
Global, days: 90
Region: Elbow

Drawn from CMSCgsmedicareAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify which epicondyle is fractured (medial vs. lateral) — laterality drives ICD-10 code selection and audit review
Document that joint manipulation was performed and describe the technique — this is the defining element separating 24565 from 24560
Record pre- and post-reduction imaging with radiology report confirming fracture position before and after manipulation
Note the type and duration of immobilization applied (long-arm cast, posterior splint, brace) and position of elbow at time of application
Document neurovascular status of the extremity before and after manipulation, including assessment of the ulnar nerve for medial epicondyle fractures
Indicate anesthesia or sedation used if manipulation was performed under conscious sedation or general anesthesia

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 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 6 cited references ↓

CPT 24565 covers closed (non-operative) treatment of a humeral epicondylar fracture — either medial or lateral epicondyle — where the treating physician performs manipulation of the elbow joint to achieve acceptable fracture reduction. The distinction from 24560 is exactly that manipulation step: if you reduce the fracture without moving the joint, bill 24560. If joint manipulation is required to seat the fragment, bill 24565. Post-reduction immobilization (splint, cast, or brace application) is included in the global package.

The 90-day global period covers the reduction, all routine follow-up, cast checks, and removal of immobilization through day 90. Bill modifier 57 on a same-day or prior-day E/M if that visit is where the decision for surgery was made — CMS's 24-hour rule applies for 90-day global procedures. Any unrelated E/M during the global requires modifier 24. If the fracture displaces after initial reduction and requires a second manipulation by the same physician, append modifier 76; by a different physician, modifier 77.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.64
Practice expense RVU	11.16
Malpractice RVU	1.21
Total RVU	18.01
Medicare national rate	$601.55
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	$601.55
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 24565 get rejected.

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

Upcoding from 24560 to 24565 without documentation confirming joint manipulation was performed — auditors look for this distinction explicitly
Missing laterality modifier (LT or RT) causing claim rejection or payer-specific denial on bilateral-edit screens
Separate billing for cast or splint application — immobilization is bundled into the global package for closed fracture treatment codes
E/M billed same day without modifier 25 (for a separately identifiable decision-making visit) or modifier 57 (decision for surgery in the 90-day global pre-op window)
Imaging billed with modifier 26 omitted when physician only interprets the X-ray and technical component was performed by a facility

Frequently asked questions

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

01What is the clinical difference between 24560 and 24565?

Manipulation of the elbow joint. 24560 is closed treatment without joint manipulation. 24565 requires you to move the joint to reduce the fracture. If your note doesn't document manipulation, payers will downcode to 24560.

02Is cast application separately billable with 24565?

No. Initial cast or splint application is bundled into all closed fracture treatment codes under the global period. Do not bill a separate casting code on the same date.

03Can I bill an E/M on the same day I perform 24565?

Only if the E/M is a separately identifiable service beyond the fracture decision and management. Append modifier 25 to the E/M. If that visit is where the decision to proceed was made and the procedure has a 90-day global, use modifier 57 instead.

04Do I need laterality modifiers LT or RT?

Yes for most payers. Medicare does not require LT/RT on elbow fracture codes by default, but most commercial payers and many MACs do. Missing laterality is a clean-claim edit failure at many clearinghouses — add it routinely.

05What if the fracture re-displaces and requires a second manipulation during the 90-day global?

If you perform the second manipulation, bill 24565 with modifier 76 (repeat procedure, same physician). If a different physician performs it, use modifier 77. Modifier 78 applies only if the patient returns to the OR for an unplanned related procedure — a second closed manipulation in the office does not use modifier 78.

06When would modifier 22 apply to 24565?

When the manipulation requires substantially greater work than typical — for example, a significantly comminuted fragment, extreme swelling requiring prolonged manipulation attempts, or a patient whose anatomy or prior surgery made reduction unusually difficult. Documentation must describe the specific circumstances adding time and complexity, not just state 'difficult case.'

07Is 24565 payable in an ASC setting?

Yes. Per CMS Physician Fee Schedule 2026, the ASC facility payment for 24565 is lower than the HOPD rate — see the site-of-service comparison table on this page. The physician fee is the same regardless of setting.

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 specific epicondyle involved (medial or lateral), the manipulation technique performed, pre- and post-reduction alignment findings from imaging, neurovascular exam findings including ulnar nerve assessment, and the immobilization method applied. This prevents the most common audit flag: an operative or procedure note that documents a fracture was treated but doesn't explicitly confirm joint manipulation occurred — the one clinical fact that distinguishes 24565 from 24560.

See how Mira captures CPT 24565 documentation