Open surgical treatment of a periarticular elbow fracture and/or dislocation involving the distal humerus, proximal ulna, and/or proximal radius, with internal fixation.

Verified May 8, 2026 · 7 sources ↓

Medicare: $989.33
Total RVUs: 29.62
Global, days: 90
Region: Elbow

Drawn from CMSFastrvuFindacodeGenhealthMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Identify the specific bones involved: distal humerus, proximal ulna, proximal radius, or combination — vague references to 'elbow fracture' are insufficient.
Describe the surgical approach by name (e.g., posterior triceps-splitting, olecranon osteotomy, lateral Kocher) — operative notes that say 'standard approach' invite audit.
Document fracture pattern, degree of displacement or comminution, and why open treatment was required over closed reduction.
List all hardware placed (plate type, screw count, size) and confirm intraoperative imaging (fluoroscopy) was obtained and findings recorded.
If dislocation was also addressed, document pre- and post-reduction neurovascular status and stability assessment.
Record any concomitant injuries treated (ligament repair, ulnar nerve transposition) and explain separate billing if applicable.

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 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 24586 covers open reduction and internal fixation (ORIF) of fractures and/or dislocations at the elbow joint — specifically the distal humerus and proximal ulna and/or proximal radius. The surgeon opens the elbow through one or more incisions, reduces the displaced fragments, and secures them with hardware (plates, screws, or pins). This is a periarticular code, meaning the fracture pattern involves the joint-bearing region of the elbow, not simply the humeral shaft.

This code carries a 90-day global period. All routine post-op visits, wound checks, and dressing changes through day 90 are bundled. Separate E/M visits during that window require modifier 24 if unrelated to the fracture, or modifier 79 if an unrelated surgical procedure is performed. Code 24587 is the add-on for the same encounter when a total elbow arthroplasty is also performed — do not use 24586 and 24587 independently without understanding that relationship.

Note that FindACode flagged 24586 as a changed code for 2026. Verify current descriptor language and any bundling edits against the 2026 NCCI tables before billing. Debridement at an open fracture site may be separately reportable with 11010–11012; debridement that is merely incidental to surgical access is not.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	15.39
Practice expense RVU	11.09
Malpractice RVU	3.14
Total RVU	29.62
Medicare national rate	$989.33
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	$989.33
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$9,087.81

Common denial reasons

The recurring reasons claims for CPT 24586 get rejected.

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

Diagnosis code does not specify the fracture as displaced, periarticular, or involving the correct anatomic structures — ICD-10 specificity mismatch.
Bilateral modifier 50 applied without documentation that both elbows were treated in the same operative session.
Separate billing for fluoroscopic guidance (76000/77002) when it is considered bundled into the open fracture procedure.
Post-op E/M visit billed without modifier 24, triggering global period denial.
Hardware removal (20680) billed within the 90-day global as a planned staged procedure without modifier 58.

Frequently asked questions

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

01What is the difference between 24586 and 24587?

24586 is the standalone code for open treatment of a periarticular elbow fracture and/or dislocation. 24587 is used when a total elbow arthroplasty is performed at the same time as that fracture treatment. They are related but not interchangeable — check the 2026 descriptor and bundling rules before pairing them.

02Can I bill separately for ulnar nerve transposition performed during this procedure?

Possibly. Per NCCI policy, ulnar nerve transposition (64718) can be separately reportable when performed alongside certain elbow procedures — unlike neuroplasty alone, which is typically bundled. Append modifier 59 or XS and document the medical necessity for transposition as a distinct service.

03Is fluoroscopy separately billable with 24586?

Generally no. Intraoperative fluoroscopy used to confirm reduction and hardware placement is considered integral to open fracture fixation and is not separately reportable. Do not bill 76000 alongside 24586 without a specific payer exception.

04What modifier applies if I need to return to the OR within the 90-day global to address a complication from the original fixation?

Use modifier 78 for an unplanned return to the OR for a complication related to the original elbow procedure. If the return surgery is for an unrelated condition, use modifier 79. Do not invert these — wrong modifier assignment is a common audit finding.

05Can debridement at the fracture site be billed separately?

Yes, if the fracture is open (bone through skin). Debridement of an open fracture or dislocation site may be reported separately using CPT codes 11010–11012. Debridement that is simply incidental to surgical access is not separately billable.

06Does 24586 support a co-surgeon arrangement (modifier 62)?

Modifier 62 is applicable when two surgeons of different specialties each perform a distinct portion of the procedure and both document their separate roles. For complex periarticular elbow fractures requiring simultaneous work by, for example, an orthopedic traumatologist and a hand surgeon, modifier 62 may be appropriate — both surgeons must submit individual operative notes.

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 pattern (distal humerus, proximal ulna, proximal radius, or combination), displacement severity, surgical approach by name, hardware description, intraoperative fluoroscopy findings, and neurovascular status before and after reduction. That detail prevents the two most common denial triggers for 24586: ICD-10 specificity mismatches and audit flags on operative notes that lack approach and implant documentation.

See how Mira captures CPT 24586 documentation