Closed reduction of radial head subluxation in a child (nursemaid's elbow) performed with manipulation.

Verified May 8, 2026 · 6 sources ↓

Medicare: $104.21
Work RVU: 1.22
Global, days: 10
Region: Elbow

Drawn from CMSAAPCEatonhandDam

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm patient age and clinical diagnosis of radial head subluxation (nursemaid's elbow), not a fracture
Document the reduction technique used — supination-flexion or hyperpronation — and the click or clunk confirming reduction
Record pre-reduction neurovascular status and post-reduction functional assessment (child using the arm freely)
Specify laterality (left or right elbow) in the procedure note and on the claim
If imaging was obtained to rule out fracture, note findings and how they informed the decision to manipulate
For failed or incomplete reductions, document the attempt, number of passes, and clinical rationale for stopping

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

25 Significant separate E/M 52 Reduced services 59 Distinct service 76 Repeat, same physician LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 24640 covers closed manipulation to reduce a radial head subluxation — classically nursemaid's elbow — in a pediatric patient. No incision, no anesthesia beyond topical or none at all. The physician uses a supination-flexion or hyperpronation technique to seat the radial head back into the annular ligament. This is a 010-day global procedure, meaning routine follow-up within 10 days is bundled.

Billing a same-day E/M with modifier 25 is appropriate and well-supported — the pre-reduction evaluation is clinically necessary to rule out fracture before manipulating the arm, and that work is separately identifiable. Don't skip the E/M; billing only 24640 leaves reimbursement on the table. Attach LT or RT to lateralize the procedure, especially when the chart involves bilateral presentations or repeat visits.

This procedure is performed overwhelmingly in emergency department and office settings. If the reduction is attempted but fails, document the attempt explicitly — an incomplete reduction with documented clinical reasoning supports billing 24640 with modifier 52 rather than writing off the encounter. For a contralateral elbow treated the same day, append modifier 59 to distinguish it as a separate anatomic site.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (1.22) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (3.12) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.22
Practice expense RVU	1.83
Malpractice RVU	0.07
Total RVU	3.12
Medicare national rate	$104.21
Global period	10 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	$104.21
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI P3) Ambulatory surgical center (freestanding)	$61.76

Common denial reasons

The recurring reasons claims for CPT 24640 get rejected.

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

E/M billed same-day without modifier 25, causing the office visit to bundle into the procedure
Missing laterality modifier LT or RT triggers claim edits with many payers
Claim submitted without pediatric age documented, raising medical necessity questions for this age-specific diagnosis
Incomplete reduction attempt billed at full value without modifier 52, flagged on audit
Diagnosis code maps to fracture rather than subluxation, mismatching the closed manipulation code

Frequently asked questions

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

01Can I bill an E/M on the same day as 24640?

Yes — append modifier 25 to the E/M. The pre-reduction evaluation to rule out fracture is a separately identifiable service. Coding only 24640 without an E/M leaves reimbursement on the table.

02What global period applies to 24640?

010-day global. Routine follow-up visits within 10 days post-reduction are bundled. Any unrelated visit in that window needs modifier 24 on the E/M.

03What if the reduction attempt fails — do I still bill 24640?

Bill 24640 with modifier 52 for a reduced service. Document the attempt, technique used, and clinical reason the reduction was incomplete or unsuccessful.

04How do I handle bilateral nursemaid's elbow reductions on the same day?

Bill 24640-LT for the first reduction and 24640-59-RT (or 24640-RT-59) for the second. Modifier 59 identifies it as a distinct anatomic site. Some payers require XS instead of 59 — verify by payer.

05Is 24640 used only for children?

The code is specifically described for nursemaid's elbow, a pediatric condition. Document patient age explicitly. Billing this code for an adult radial head dislocation without supporting clinical context invites a medical necessity denial.

06Does 24640 require anesthesia to bill?

No — the procedure is closed manipulation without anesthesia. If general or regional anesthesia is required, reassess whether a higher-level elbow dislocation code is more appropriate.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the reduction technique (supination-flexion or hyperpronation), the confirmatory click or clunk, laterality, pre- and post-reduction neurovascular exam, and whether imaging was obtained to exclude fracture. That documentation set prevents the two most common denials: an E/M bundled for lack of modifier 25 support, and a medical necessity flag when the note doesn't distinguish subluxation from fracture.

See how Mira captures CPT 24640 documentation