Closed treatment of elbow dislocation requiring anesthesia — the joint is manually reduced without an incision, but the complexity necessitates general or regional anesthesia.

Verified May 8, 2026 · 6 sources ↓

Medicare: $479.30
Total RVUs: 14.35
Global, days: 90
Region: Elbow

Drawn from CMSAAPCFindacodeMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify dislocation type (posterior, anterior, lateral, medial) and which structures are involved
Confirm closed technique — no incision made, manipulation only
Document anesthesia type used (general, regional, conscious sedation) and clinical justification for its necessity
Record pre- and post-reduction neurovascular status, including radial pulse, sensation, and motor function
Include post-reduction imaging confirming joint congruity and ruling out associated fracture
Note any associated ligamentous or osseous injury identified on exam or imaging that may affect code selection or support modifier 22

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 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 24605 covers closed reduction of a dislocated elbow performed under anesthesia. No incision is made — the physician manipulates the joint back into proper alignment — but the procedure requires anesthesia, distinguishing it from 24600, which is performed without anesthesia. The anesthesia requirement typically reflects complexity: significant muscle spasm, patient inability to tolerate manipulation awake, or an unstable dislocation pattern.

The 90-day global period applies. That window covers the operative session, the day-before visit, and all routine post-op care through day 90 — including splint checks, wound care, and follow-up imaging reviews directly related to the dislocation. Billing a separate E/M during the global for a related complaint requires modifier 24. A same-day E/M, if separately identifiable, requires modifier 25.

Site of service matters here. HOPD and ASC payments differ substantially (see the Site of Service comparison on this page). Most straightforward elbow reductions will land in the ED or an ASC; document the facility type accurately on the claim. If the same dislocation recurs and requires repeat reduction — whether by the same or a different provider — modifiers 76 or 77 apply, respectively. Append modifier 22 when documentation supports materially increased intraoperative complexity.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.5
Practice expense RVU	7.65
Malpractice RVU	1.2
Total RVU	14.35
Medicare national rate	$479.30
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	$479.30
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 24605 get rejected.

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

Billed as 24605 when anesthesia was not used — payers downcode to 24600
Separate E/M billed during the 90-day global without modifier 24 or 25
Missing post-reduction imaging documentation to confirm closed reduction was achieved
Anesthesia necessity not documented — payer unable to distinguish from 24600 level of service
Modifier 76 or 77 omitted on repeat reduction of same dislocation

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What is the difference between CPT 24600 and 24605?

24600 is closed elbow reduction without anesthesia; 24605 requires anesthesia. If your operative note doesn't explicitly document anesthesia use and the clinical reason for it, payers will downcode to 24600.

02Can I bill a separate E/M during the 90-day global period?

Yes, but only with the correct modifier. Modifier 24 is required for an E/M unrelated to the elbow dislocation. Modifier 25 covers a separately identifiable E/M on the same day as the procedure. Without one of these, the E/M will be denied as bundled into the global.

03The patient's elbow dislocated again two weeks later and I reduced it again. How do I bill the repeat procedure?

Append modifier 76 if you're the same physician performing the repeat reduction, or modifier 77 if a different physician does it. Bill 24605 again if anesthesia was used; 24600 if not. Document the new episode clearly — do not rely on the original operative note.

04The dislocation also had an associated radial head fracture. Does that change my code selection?

Potentially yes. A dislocation with an associated fracture may be separately reportable or may shift you to a different primary code depending on the fracture treatment rendered. Review whether a fracture-specific code better captures the primary service, and apply modifier 59 if billing both dislocation treatment and fracture treatment as distinct procedures.

05Does 24605 carry a facility vs. non-facility payment difference?

Yes. The physician's reimbursement differs based on where the procedure is performed — HOPD, ASC, or office/ED. See the Site of Service comparison on this page for current 2026 amounts under CMS Physician Fee Schedule 2026.

06When is modifier 22 appropriate for 24605?

Use modifier 22 when the reduction required substantially more work than typical — for example, a chronic or recurrent dislocation with significant muscular contracture, or a complex instability pattern requiring extended manipulation. The operative note must clearly articulate the added time and difficulty; modifier 22 without supporting documentation will be denied.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures dislocation direction, anesthesia type and justification, pre- and post-reduction neurovascular exam findings, post-reduction imaging results, and any associated fracture or ligament injury noted intraoperatively. This prevents the most common 24605 denial: a payer downcode to 24600 because the operative note fails to clearly establish why anesthesia was required.

See how Mira captures CPT 24605 documentation