Percutaneous skeletal fixation of a medial or lateral humeral epicondylar fracture, performed with manipulation to restore alignment before pin or wire placement through the skin.

Verified May 8, 2026 · 5 sources ↓

Medicare: $690.73
Total RVUs: 20.68
Global, days: 90
Region: Elbow

Drawn from CMSEmednyCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify medial or lateral epicondyle — documentation must name which epicondyle is fractured
Confirm manipulation was performed to reduce the fracture fragment prior to fixation
Describe the percutaneous fixation technique: number, type, and placement of pins or wires
Record laterality of the injured extremity (left or right) to support LT/RT modifier use
Include pre- and post-reduction imaging findings to justify fixation over closed treatment
Document neurovascular status of the extremity before and after the procedure

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 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 24566 covers percutaneous skeletal fixation of a humeral epicondylar fracture — medial or lateral — with manipulation. The surgeon reduces the displaced epicondyle fragment and holds the reduction by driving pins or wires through the skin into bone, avoiding an open incision. This distinguishes 24566 from closed treatment with manipulation (24565) and from open internal fixation (24575). If you're deciding between codes, the key fork is whether you crossed the skin with hardware: if yes without a formal open approach, that's 24566.

The 90-day global period means routine post-op visits, pin-site care, and hardware monitoring through day 90 are bundled. Bill unrelated E/M services in the global window with modifier 24; bill separately identifiable same-day E/M with modifier 25 if it drove the surgical decision at a distinct encounter. Hardware removal after fracture healing is a separate procedure with its own code — not included in the 24566 global.

Site-of-service matters for payment. HOPD and ASC rates differ substantially (see the Site of Service comparison table). Because epicondylar fractures are common in pediatric patients after falls, documentation must be precise about laterality (medial vs. lateral epicondyle), confirmation of manipulation performed, and fixation method — payers audit these three elements routinely.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.83
Practice expense RVU	9.97
Malpractice RVU	1.88
Total RVU	20.68
Medicare national rate	$690.73
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	$690.73
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 24566 get rejected.

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

Missing laterality documentation causes claim rejection or modifier-related denial
Upcoding flags when operative note lacks explicit confirmation that manipulation was performed before pin insertion
Bundling denial when 24566 is billed alongside 24565 or 24575 for the same fracture on the same date without supporting documentation
Global period denial when post-op visits are billed without modifier 24 during the 90-day window
Medical necessity denial when imaging is not documented to support percutaneous fixation over closed treatment

Frequently asked questions

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

01What separates 24566 from 24565 and 24575?

24565 is closed treatment of a humeral epicondylar fracture with manipulation — no hardware crosses the skin. 24566 adds percutaneous pin or wire fixation through the skin. 24575 is open treatment with a formal incision and internal fixation. If you manipulated and pinned percutaneously, that's 24566. If you opened the fracture site, use 24575.

02Can 24566 and 24565 be billed together?

No. Closed treatment with manipulation (24565) is a component of percutaneous fixation with manipulation (24566). Billing both for the same fracture on the same date will trigger an NCCI bundling edit and the lesser code will deny.

03Does the 90-day global include pin removal?

Routine pin removal during the 90-day global is generally bundled. If removal requires a separate operative session due to complication or complexity, bill with modifier 78 (unplanned return for a related procedure in the global) and document the clinical reason.

04When is modifier 22 appropriate for 24566?

Use modifier 22 when the fracture complexity — comminution, prior hardware, obesity, or difficult reduction — required substantially more intraoperative work than typical. Attach a written justification letter; payers require documentation beyond a generic 'increased complexity' notation.

05Is 24566 billed differently for pediatric patients?

The CPT code is the same regardless of patient age, but pediatric epicondylar avulsion fractures are among the most common indications. Document growth plate involvement if present — it supports medical necessity for fixation and may be relevant to ICD-10 specificity on the claim.

06What modifier do I use if both elbows are treated in the same session?

Bilateral epicondylar fracture fixation is rare but if it occurs, append modifier 50 to 24566 on a single claim line. Some payers instead require LT and RT on two separate lines — verify your MAC's preference before submitting.

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 location (medial vs. lateral epicondyle), the surgeon's dictated confirmation that manipulation was performed, the number and placement of percutaneous pins or wires, operative laterality, and pre/post-reduction imaging findings. That detail set prevents the two most common audit flags: a note that documents fixation without confirming manipulation, and a claim missing laterality that triggers an automatic edit.

See how Mira captures CPT 24566 documentation