Closed treatment of a humeral condyle fracture at the elbow, without manipulation — no incision, no reduction performed.

Verified May 8, 2026 · 5 sources ↓

Medicare: $409.83
Work RVU: 2.98
Global, days: 90
Region: Elbow

Drawn from CMSAAPCCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify which condyle is fractured — lateral or medial — and laterality (LT/RT)
Confirm no manipulation was performed and document clinical rationale for non-manipulative treatment
Include pre-treatment imaging (X-ray or CT) with findings demonstrating fracture characteristics and displacement status
Document immobilization method applied (splint, cast, brace) and neurovascular status of the limb at time of service
Record post-treatment plan including weight-bearing restrictions and follow-up interval within the 90-day global

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 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 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 24576 covers closed management of a single humeral condyle fracture where no manipulation is required. The condyle — either the lateral or medial bony prominence at the distal humerus — is treated non-operatively because the fracture is deemed sufficiently stable or nondisplaced on imaging. No incision is made, and no reduction maneuver is performed. The 90-day global period begins on the date of service and includes all follow-up visits, splint or cast checks, and routine wound or dressing management through day 90.

If the fracture subsequently requires manipulation or open reduction within the global period, that return procedure is reported with modifier 78 (unplanned return to the OR for a related procedure) or modifier 58 (staged or planned follow-on procedure), depending on whether it was anticipated at the outset. If an unrelated elective procedure is performed during the global window, use modifier 79. Documentation must clearly distinguish the condyle involved (lateral vs. medial) and confirm that no manipulation was performed — the absence of that confirmation is a common audit flag.

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 (2.98) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (12.27) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.98
Practice expense RVU	8.65
Malpractice RVU	0.64
Total RVU	12.27
Medicare national rate	$409.83
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	$409.83
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 24576 get rejected.

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

Condyle not specified (lateral vs. medial) in the operative or clinical note, causing diagnosis-procedure mismatch
No imaging documentation on file to support the fracture diagnosis at the time of billing
Global period violation — follow-up E/M billed without modifier 24 during the 90-day window
Upcoding concern flagged when manipulation is documented in the note but 24576 (without manipulation) is reported instead of 24577
Laterality modifiers LT/RT omitted, triggering payer edit requiring resubmission

Frequently asked questions

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

01What is the difference between CPT 24576 and 24577?

24576 is closed treatment without manipulation — the fracture is stable enough that no reduction is needed. 24577 is closed treatment with manipulation, meaning active reduction was performed. Bill based on what was actually done, not on fracture severity alone. Mismatching these two codes to the documentation is a top audit target.

02Can I bill an E/M visit on the same day as 24576?

Yes, if the E/M is a separately identifiable service beyond the fracture treatment decision. Append modifier 25 to the E/M. Document the distinct clinical decision-making — for example, evaluation of a comorbidity or a separate complaint — not just the fracture assessment.

03How do I bill if the fracture later requires open reduction during the 90-day global?

If the open reduction was unplanned, report the open reduction code with modifier 78. If it was staged or anticipated at the time of the initial treatment, use modifier 58. Do not bill the follow-up fracture care without a modifier — it will deny as bundled into the global.

04Is 24576 billable bilaterally?

Bilateral condyle fractures are exceedingly rare, but if both elbows are treated at the same encounter, append modifier 50 and document separate clinical findings for each elbow. Most payers will require separate line items with LT and RT rather than a single bilateral unit.

05Do laterality modifiers LT and RT matter for 24576?

Yes. Most commercial payers and many MACs require LT or RT on upper-extremity fracture codes. Omitting laterality is a common, easily corrected denial reason. Append the appropriate modifier on every claim line.

06What ICD-10 codes pair with 24576?

The S42.4xx series covers fractures of the lateral and medial condyle of the humerus. Select the specific code reflecting the condyle involved, laterality, displacement status, and encounter type (initial care = A, subsequent = D, sequela = S). A mismatch between a displaced-fracture ICD-10 code and 24576 (which implies nondisplaced or minimally displaced) can trigger a medical necessity review.

Sources & references

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

Mira Scribe

Mira's AI scribe captures condyle laterality, fracture displacement status from imaging, the specific immobilization applied, and the explicit statement that no manipulation was performed. This prevents the most common audit flag for 24576 — operative or clinical notes that describe the fracture without confirming the no-manipulation rationale — and ensures the ICD-10 code assigned matches the documented condyle (lateral vs. medial).

See how Mira captures CPT 24576 documentation