Open treatment of a partial articular fracture and/or dislocation of the elbow with internal fixation of the articular fragment.

Verified May 8, 2026 · 7 sources ↓

Medicare: $999.35
Total RVUs: 29.92
Global, days: 90
Region: Elbow

Drawn from CMSAAOSEatonhandAAPC

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Operative note must specify the fracture pattern (partial articular) and confirm intra-articular involvement — 'elbow fracture' alone is insufficient.
Document the exact approach used (e.g., lateral, posterolateral, Kocher) by name; notes that say 'standard approach' flag on audit.
Internal fixation method and hardware used (screw type, size, number of fragments fixed) must be recorded.
Preoperative imaging (X-ray or CT) confirming partial articular fracture pattern and any associated dislocation should be in the record.
If modifier 22 is appended, the note must quantify why the work was substantially greater — fracture comminution, prior hardware, altered anatomy, or prolonged operative time with explicit surgeon attestation.
Concurrent ligamentous injury or repair must be documented separately and distinctly from the fracture fixation to support additional code(s).

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 57 Decision for surgery 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 24587 covers open surgical treatment of a partial articular fracture and/or dislocation at the elbow, including internal fixation of the articular fragment. This is a high-complexity procedure requiring direct visualization and stabilization of intra-articular fracture components — not simply closed manipulation or percutaneous pinning. The 90-day global period begins on the date of surgery and encompasses all routine post-op management through day 90.

When concurrent ligamentous injury is repaired in the same operative session (e.g., lateral collateral ligament reconstruction billed with 24343), expect scrutiny and potential bundling edits. NCCI policy bundles many same-site elbow procedures; use modifier 59 or XS only when the additional procedure meets the distinct anatomic site or separate encounter criteria defined in the NCCI policy manual — different diagnosis alone does not satisfy the requirement.

Radiologic guidance (fluoroscopy) used intraoperatively to confirm reduction and fixation is generally considered bundled into 24587 and should not be billed separately. If imaging is used for a separate, distinct procedure on the same date, separate reporting may be appropriate per NCCI guidance.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	15.4
Practice expense RVU	11.25
Malpractice RVU	3.27
Total RVU	29.92
Medicare national rate	$999.35
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	$999.35
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$9,558.44

Common denial reasons

The recurring reasons claims for CPT 24587 get rejected.

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

Bundling denial when 24343 (lateral collateral ligament repair) is billed same-day without a modifier supported by distinct documentation of a separate procedure.
Separate fluoroscopy code denied as unbundled — intraoperative imaging is considered included in the open treatment code per NCCI policy.
Claim denied during the 90-day global of a prior elbow procedure without modifier 58, 78, or 79 to indicate staged, related unplanned, or unrelated status respectively.
Diagnosis code mismatch — partial articular fracture (ICD-10 S52.x with appropriate 7th character for initial vs. subsequent encounter) must align with the open treatment reported.
Missing or inadequate documentation of intra-articular involvement causes downcoding or denial when only extra-articular fracture is supported by the record.

Frequently asked questions

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

01Is fluoroscopy separately billable with CPT 24587?

No. Intraoperative fluoroscopy used to confirm reduction and fixation during open elbow fracture treatment is bundled into 24587 per NCCI policy and cannot be separately reported.

02Can I bill 24343 for a lateral collateral ligament repair performed during the same session as 24587?

It has been billed, but Workers' Comp and Medicare carriers frequently deny 24343 as bundled. You need modifier 59 or XS with strong operative documentation that the ligament repair was a distinct procedure — not incidental to the fracture exposure. Expect appeal work if denied.

03What modifier applies if the patient returns to the OR during the 90-day global for a related complication?

Modifier 78. That covers an unplanned return to the operating room for a related procedure within the global period. Do not use modifier 79 for a related procedure — 79 is for unrelated procedures only.

04When should modifier 57 be used with 24587?

Append modifier 57 to the E/M code when the decision for surgery was made at a visit the day of or day before the procedure. Because 24587 carries a 90-day global, that preoperative E/M would otherwise be swallowed by the global without it.

05Does CPT 24587 require a specific ICD-10 seventh character?

Yes. Use the 'A' seventh character for the initial encounter (active treatment), 'D' for subsequent routine care, and 'S' for sequela. Billing 24587 with a 'D' (subsequent encounter) diagnosis on the same date as initial open treatment is a mismatch that triggers denial.

06What distinguishes 24587 from other elbow fracture codes?

24587 is specifically for partial articular fractures with open treatment and internal fixation of the articular fragment. It is not used for extra-articular fractures, closed treatment, or complete articular fractures — those map to different codes. The 'partial articular' specificity must be confirmed in both imaging and the operative note.

Sources & references

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

Mira AI Scribe

The Mira AI Scribe captures the fracture pattern (partial articular vs. complete articular), specific surgical approach by name, hardware placed, intra-articular extent confirmed on fluoroscopy, and any concurrent soft-tissue repairs documented as distinct procedures. This prevents the most common audit flag — an operative note that describes fixation without confirming articular involvement — which triggers downcoding or outright denial when the partial articular specificity required for 24587 is absent.

See how Mira captures CPT 24587 documentation