Open surgical repair of a medial or lateral humeral epicondyle fracture at the elbow, with internal fixation applied when needed to stabilize the fragment.

Verified May 8, 2026 · 7 sources ↓

Medicare: $694.74
Total RVUs: 20.8
Global, days: 90
Region: Elbow

Drawn from CMSAbosNIHCgsmedicareAAPC

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify whether the fracture is medial or lateral epicondyle — the code is the same but documentation must match the diagnosis code (ICD-10 laterality required).
State that the approach was open (direct incision over the epicondyle), not closed or percutaneous — the open approach is what justifies 24575 over closed treatment codes.
Document whether internal fixation was applied: if yes, specify implant type (e.g., cannulated screw, suture anchor, K-wire) and the rationale for fixation versus no fixation.
Include fracture characterization — displacement, fragment size, associated ligamentous injury, or concomitant elbow dislocation — to support medical necessity and any modifier 22 claim.
Record neurovascular status before and after reduction, particularly ulnar nerve assessment for medial epicondyle fractures given proximity of the nerve.
Operative note must name the approach (e.g., medial or lateral incision) — notes that state only 'standard approach' are audit targets.

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 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 73 Discontinued pre-anesthesia 74 Discontinued post-anesthesia 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 7 cited references ↓

CPT 24575 covers open treatment of a humeral epicondylar fracture — medial or lateral — at the elbow. The surgeon makes a direct incision over the affected epicondyle, reduces the fracture, and applies internal fixation hardware (screws, suture anchors, or other implants) when the fracture pattern requires it. The phrase 'when performed' means fixation is not always placed, but the code applies regardless — the critical distinction is that the approach is open, not percutaneous or closed.

This code sits in a family of distal humerus fracture codes. Use 24545/24546 for supracondylar or transcondylar patterns and 24579 for condylar fractures. Epicondylar fractures — the medial epicondyle being far more common, especially in pediatric patients following elbow dislocation — are distinct anatomically and coded separately. Medial versus lateral epicondyle involvement does not change the CPT code; both are captured under 24575.

The 90-day global period applies. All routine post-op visits, hardware checks, cast/splint changes, and wound care through day 90 are bundled. Bill unrelated E/M services with modifier 24 and same-day separately identifiable E/M services with modifier 25. If a concomitant elbow dislocation is reduced at the same session, review NCCI edits before appending a bypass modifier.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.47
Practice expense RVU	9.39
Malpractice RVU	1.94
Total RVU	20.8
Medicare national rate	$694.74
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	$694.74
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$8,621.29

Common denial reasons

The recurring reasons claims for CPT 24575 get rejected.

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

ICD-10 laterality mismatch — diagnosis code does not specify the same side (medial vs. lateral, left vs. right) documented in the operative report.
Upcoding flag when 24575 is billed for a condylar fracture better described by 24579 — payers and auditors distinguish epicondylar from condylar anatomy, and conflating the two draws downcoding or denial.
Global period violations — post-op E/M visits billed without modifier 24 when the visit is unrelated, or with modifier 24 when the visit is actually related to the fracture repair.
Missing internal fixation documentation when an implant code (e.g., a hardware supply code) is billed alongside 24575 but the operative note does not confirm fixation was placed.
Same-day E/M billed without modifier 25 when a separate decision-for-surgery visit occurred on the day of the procedure.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Does 24575 cover both medial and lateral epicondyle fractures?

Yes. The code explicitly includes medial or lateral epicondylar fractures. The distinction matters for your ICD-10 diagnosis code (which must reflect the correct side and location) but does not change the CPT selection.

02When should I use 24579 instead of 24575?

Use 24579 for humeral condylar fractures — the condyle is the rounded articular projection distal to the epicondyle. The epicondyle is the bony prominence above and proximal to the condyle. Anatomy in the operative note and imaging drives this distinction; conflating the two is a common audit finding.

03Can I bill 24575 if no internal fixation was used?

Yes. The descriptor includes 'when performed,' meaning 24575 applies to open treatment whether or not hardware was placed. The key qualifier is that the approach was open — if the fracture was managed closed or percutaneously, 24575 is not appropriate.

04What modifiers apply when treating both elbows in the same session?

Bilateral epicondyle fractures are rare but possible. Bill 24575 with modifier 50 for bilateral same-session treatment, or with LT and RT on separate lines per payer preference. Verify your payer's bilateral surgery indicator rules before submitting.

05How does the 90-day global affect post-op ulnar nerve complications?

Treatment of ulnar nerve problems that arise as a direct complication of the medial epicondyle repair is bundled into the global unless it requires a return to the OR. An unplanned return to the OR for a related complication bills with modifier 78. A new unrelated nerve procedure bills with modifier 79. Document clearly whether the complication is related to the index procedure.

06Is fluoroscopy separately billable with 24575?

Per CMS NCCI policy, fluoroscopy used intraoperatively during fracture fixation is generally considered integral to the procedure. Separately billing a fluoroscopy code (e.g., 76000) alongside 24575 will typically deny. Confirm against current NCCI PTP edits for the specific code pair before billing.

07What ICD-10 codes pair with 24575?

Look to the S49 category for physeal fractures (pediatric) and the S52 category for other specified fractures of the elbow region. Confirm laterality (left/right) and displacement status in your diagnosis code — these must match the operative documentation exactly to avoid mismatch denials.

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, left vs. right), confirms the approach as open with direct incision, records whether internal fixation was placed and the implant type, and flags ulnar nerve assessment for medial epicondyle cases. That documentation chain prevents laterality-mismatch denials and audit flags from operatives notes that omit approach or fixation detail.

See how Mira captures CPT 24575 documentation