Closed treatment of a Monteggia fracture-dislocation at the elbow — proximal ulna fracture combined with radial head dislocation — performed with manipulation and without surgical incision.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $567.82
- Total RVUs
- 17
- 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 ↓
- Explicit identification of injury as Monteggia type: proximal ulna fracture with radial head dislocation — not just 'elbow fracture'
- Pre- and post-reduction imaging confirming both components (ulna fracture and radial head position) were addressed
- Description of manipulation technique and confirmation that no incision was made (closed treatment)
- Type of immobilization applied (long-arm cast, posterior splint, etc.) and position of forearm at time of application
- Neurovascular status documented pre- and post-reduction, specifically anterior interosseous nerve function
- ICD-10 fracture code must specify laterality (right vs. left) and encounter type (initial: A, subsequent: D, sequela: S)
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 24620 covers closed (non-operative) reduction of a Monteggia lesion: a fracture of the proximal ulna coupled with dislocation of the radial head. The treating physician manually manipulates the fracture and dislocation back into anatomical alignment, then immobilizes the construct — typically with a long-arm cast or splint — without opening the skin. This is a distinctly complex injury pattern; the radial head dislocation is easy to miss on initial imaging, and incomplete reduction of either component is a common audit and liability flag.
The 90-day global period covers the manipulation, all casting and splint changes, and routine post-reduction office visits through day 90. Any visit or procedure unrelated to the Monteggia injury during that window requires modifier 24 (E/M) or modifier 79 (unrelated procedure) to support separate billing. If the closed reduction fails and open treatment becomes necessary, that subsequent operative procedure is billed with modifier 58 (staged or related procedure in the global period).
Billing site matters here. HOPD and ASC payments differ substantially — see the Site of Service comparison table on this page. Emergency department is the most common place of service for this injury, and coders should confirm that the facility setting matches the claim before submission.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 7.04 |
| Practice expense RVU | 8.47 |
| Malpractice RVU | 1.49 |
| Total RVU | 17 |
| Medicare national rate | $567.82 |
| 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 | $567.82 |
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 24620 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- ICD-10 diagnosis code missing laterality or using wrong encounter suffix — payers reject non-specific fracture codes for surgery claims
- Radial head dislocation component not documented or coded separately, causing payers to question medical necessity for the 24620 level of service versus a simpler elbow fracture code
- Separate billing for casting or splint application during the global period — those services are included in 24620 and not separately payable
- E/M visit billed within the 90-day global without modifier 24, triggering automatic bundling edits
- Missing post-reduction imaging documentation, leading to medical necessity denial for the manipulation claim
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What is a Monteggia fracture-dislocation and why does it need its own CPT code?
02When should I use 24620 versus 24635 (open treatment)?
03Is a cast or splint application separately billable with 24620?
04What modifier do I use if the closed reduction fails and the patient needs open surgery within the 90-day global?
05Can I bill an E/M visit on the same day as the closed reduction?
06Does 24620 require prior authorization?
07What ICD-10 codes pair with 24620?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01aapc.comhttps://www.aapc.com/codes/cpt-codes/24620
- 02bedrockbilling.comhttps://bedrockbilling.com/static/cci/24620
- 03cms.govhttps://www.cms.gov/files/document/03-chapter3-ncci-medicare-policy-manual-2026-final.pdf
- 04payerprice.comhttps://payerprice.com/rates/24620-CPT-fee-schedule
- 05findacode.comhttps://www.findacode.com/cpt/24620-cpt-code.html
- 06CMS Physician Fee Schedule 2026
Mira AI Scribe
Mira's AI scribe captures the injury classification (Monteggia lesion, proximal ulna fracture with radial head dislocation), laterality, manipulation technique, confirmation of closed approach, immobilization type and forearm position, and pre/post-reduction neurovascular exam — including anterior interosseous nerve status. That specificity prevents the two most common denials: non-specific fracture coding and payer challenges to closed-treatment medical necessity when the radial head component isn't explicitly documented.
See how Mira captures CPT 24620 documentation