Closed treatment of a medial or lateral humeral condylar fracture requiring manipulation to achieve acceptable alignment

Verified May 8, 2026 · 5 sources ↓

Medicare: $617.92
Work RVU: 5.86
Global, days: 90
Region: Elbow

Drawn from CMSAbosAAPC

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 condyle — the note must name which condyle was fractured and treated
Document that manipulation was performed and describe the technique used to achieve reduction
Record pre- and post-manipulation radiographic findings confirming the reduction attempt
State the immobilization method applied (cast, splint, sling) and the position of immobilization
Document the mechanism of injury and clinical presentation including neurovascular status of the limb
Confirm closed (non-surgical) approach — no incision made, no percutaneous pin placement

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 LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 24577 covers closed (non-operative) management of a medial or lateral condylar fracture of the distal humerus when manipulation is required to reduce the fracture. The condyle is reduced by manual force without surgical incision; immobilization typically follows. This code is distinct from 24576, which is closed treatment without manipulation, and from 24579 (open treatment with internal fixation) and 24582 (percutaneous skeletal fixation with manipulation).

The 90-day global period covers the manipulation, all routine post-reduction office visits, cast or splint changes, and fracture checks through day 90. Any service unrelated to the fracture billed within that window requires modifier 24. If a new or worsening problem arises that demands a significant, separately identifiable E/M on the same day as a global-period visit, append modifier 24 with supporting documentation.

Humeral condylar fractures are common pediatric injuries but also occur in adults following high-energy elbow trauma. Laterality — medial versus lateral condyle — must be documented in the operative or clinical note; the code covers both, but the medical record must specify which condyle was treated. If post-reduction imaging confirms inadequate reduction requiring surgical conversion, 24577 is not re-billed; the open or percutaneous code replaces it.

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 (5.86) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (18.5) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.86
Practice expense RVU	11.39
Malpractice RVU	1.25
Total RVU	18.5
Medicare national rate	$617.92
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	$617.92
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 24577 get rejected.

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

Billed with 24576 (without manipulation) on the same date — only one closed condylar fracture code is reportable per encounter
Missing laterality documentation; payer cannot confirm medial vs. lateral condyle without explicit note language
Global period violation — E/M billed within 90-day global without modifier 24 and documentation of an unrelated condition
Upcoding concern when post-reduction imaging is absent from the record, leaving manipulation unsubstantiated
Incorrect code selection when percutaneous pin fixation was performed — that maps to 24582, not 24577

Frequently asked questions

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

01What is the difference between 24576 and 24577?

24576 is closed treatment of a humeral condylar fracture without manipulation — the fracture is in acceptable position and only immobilization is applied. 24577 requires active manipulation to reduce the fracture before immobilization. If you manipulated the fracture, bill 24577. If you only immobilized an already-aligned fracture, bill 24576.

02Can 24577 and 24579 be billed together if manipulation was attempted before deciding to open the fracture?

No. If the same surgeon converts to an open procedure during the same operative session, bill only the open treatment code (24579). The attempted closed manipulation is bundled into the decision to proceed with open fixation and is not separately reportable.

03Is modifier 50 appropriate for bilateral condylar fractures?

Bilateral humeral condylar fractures are rare but possible in high-energy trauma. If both elbows are treated at the same session, append modifier 50 (or LT/RT on separate lines per payer preference) and document each fracture independently. Some payers require separate line items with LT and RT rather than a single line with modifier 50 — verify with the specific payer before submitting.

04How does the 90-day global period affect post-reduction cast changes?

Routine cast changes and fracture-check visits within 90 days are included in 24577 and cannot be billed separately. If the patient develops a complication unrelated to the condylar fracture — say, a new injury — that E/M visit requires modifier 24 and a distinct diagnosis code to get paid.

05When should modifier 22 be considered for 24577?

Append modifier 22 when the manipulation required substantially more effort than typical — for example, extreme swelling, obesity, or a delayed presentation with early callus requiring forceful reduction. The operative note must describe the specific factors that increased complexity and time. Expect a cover letter and potential payer review; modifier 22 routinely triggers manual adjudication.

06Does 24577 cover both adult and pediatric humeral condylar fractures?

Yes. The code is not age-restricted. Lateral condyle fractures are among the most common pediatric elbow injuries; medial condyle fractures are less common but occur across age groups. Regardless of patient age, the documentation requirements — condyle specified, manipulation documented, imaging recorded — are identical.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the specific condyle injured (medial or lateral), the manipulation technique, pre- and post-reduction alignment on imaging, and the immobilization applied — the four elements most likely to be missing from a rushed dictation. A note that omits which condyle was treated or fails to describe the manipulation maneuver creates a documentation gap that auditors flag and payers use to deny or downcode to 24576.

See how Mira captures CPT 24577 documentation