Open surgical repair of a humeral condyle fracture, accessing the fracture site through an incision and stabilizing the bone with internal fixation hardware.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $780.25
- Total RVUs
- 23.36
- Global, days
- 90
- Region
- Elbow
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 condyle is fractured (lateral or medial) and the laterality (left or right arm)
- Operative note must name the surgical approach — lateral, medial, or extensile — not just 'standard approach'
- Document fracture displacement, angulation, and stability findings that justify open rather than closed or percutaneous treatment
- Record all implants used (plates, screws, pins) including manufacturer and implant identifiers if required by facility
- Document neurovascular status pre- and post-reduction, especially radial nerve and ulnar nerve assessment
- Pre-operative imaging (X-ray, CT if obtained) linked to the operative diagnosis and fracture classification
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 6 cited references ↓
CPT 24579 covers open treatment of a humeral condylar fracture — one of the two rounded articular projections at the distal humerus forming the elbow joint. The surgeon opens the elbow, reduces the displaced condylar fragment, and stabilizes it with plates, screws, or pins. This is distinct from percutaneous fixation (24582) and from periarticular fracture-dislocation repairs (24586–24587).
Indications include displaced or unstable condylar fractures that cannot be reduced closed, fractures with significant angulation or rotation, and those involving neurovascular compromise. The 90-day global period covers the operative day, any day-before visit, and all routine post-op care through day 90. E/M services during that window require modifier 24 (unrelated) or 25 (same-day, separate problem). Unplanned return to the OR for a related complication bills with modifier 78; an unrelated procedure in the global window uses modifier 79.
Site of service matters. HOPD and ASC payments differ significantly — see the Site of Service comparison table. Laterality modifiers LT and RT are expected on all extremity claims; missing them is a top reason for payer rejection on elbow fracture codes.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 11.15 |
| Practice expense RVU | 9.91 |
| Malpractice RVU | 2.3 |
| Total RVU | 23.36 |
| Medicare national rate | $780.25 |
| 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 | $780.25 |
HOPD (APC 5115) Hospital outpatient department | $13,116.76 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $8,821.14 |
Common denial reasons
The recurring reasons claims for CPT 24579 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing laterality modifier (LT or RT) — most commercial and Medicare plans reject elbow fracture claims without it
- ICD-10 fracture code does not specify laterality or displacement status, creating a CPT-diagnosis mismatch
- Global period conflict: post-op E/M billed without modifier 24 during the 90-day window gets automatically bundled
- Upcoding concern when documentation does not support open treatment — payors audit for closed or percutaneous technique language in the op note
- Modifier 22 appended without a separate supporting narrative explaining why work exceeded typical complexity
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What is the difference between CPT 24579 and CPT 24582?
02Do I need a laterality modifier on 24579?
03Can I bill a post-op visit during the 90-day global period?
04When is modifier 22 appropriate for 24579?
05If the surgeon needs to return to the OR during the global period for elbow wound dehiscence, what modifier applies?
06Which ICD-10 codes pair with 24579?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02aapc.comhttps://www.aapc.com/codes/cpt-codes/24579
- 03findacode.comhttps://www.findacode.com/cpt/24579-cpt-code.html
- 04mdclarity.comhttps://www.mdclarity.com/cpt-code/24579
- 05payerprice.comhttps://payerprice.com/rates/24579-CPT-fee-schedule
- 06cms.govhttps://www.cms.gov/files/document/2025nccimedicarepolicymanualcompletepdf.pdf
Mira AI Scribe
Mira's AI scribe captures condyle laterality (medial vs. lateral), approach name, fracture displacement and stability characterization, implants placed, and neurovascular exam findings from dictation. That prevents the two most common audit flags: an op note that says 'standard approach' and a claim with no laterality modifier — both of which trigger manual review or outright denial.
See how Mira captures CPT 24579 documentation