Closed treatment of a radial head or neck fracture at the elbow, without manipulation of the bone fragments.

Verified May 8, 2026 · 6 sources ↓

Medicare: $301.61
Work RVU: 2.25
Global, days: 90
Region: Elbow

Drawn from CMSMdclarityPayerpriceFindacodeGenhealth

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Imaging review confirming radial head or neck fracture with documented alignment assessment
Explicit statement that no manipulation was performed or required
Type of immobilization applied (splint, cast, sling) or clinical rationale if none used
Treatment plan for nonoperative management, including follow-up instructions
Laterality documented (left vs. right elbow) to support LT/RT modifiers on claims
Mechanism of injury and neurovascular status of the extremity

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 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 24650 covers nonsurgical management of a radial head or neck fracture where the fracture is in acceptable alignment and does not require the physician to manually reposition bone fragments. The treating provider evaluates the elbow clinically and radiographically, confirms satisfactory alignment, and immobilizes the extremity — typically with a splint, cast, or sling. No manipulation is performed; if manipulation is required, use 24655 instead.

The code carries a 90-day global period. That window includes the day-of and day-before visits, the fracture care itself, and all routine follow-up through day 90 — cast checks, repeat imaging interpretation, and routine dressing changes. Anything unrelated to the fracture billed during the global period needs modifier 24 (E/M) or 79 (unrelated procedure).

This code is most commonly billed out of the emergency department (POS 23) or office (POS 11), and hand surgery is the top-billing specialty per CMS PUF data. A sling alone with pain medication can support 24650 if the note documents fracture confirmation on imaging, alignment assessment, and the clinical rationale for nonoperative management — but the immobilization device and treatment plan must be explicitly documented.

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 (2.25) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (9.03) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.25
Practice expense RVU	6.33
Malpractice RVU	0.45
Total RVU	9.03
Medicare national rate	$301.61
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	$301.61
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI P2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 24650 get rejected.

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

Operative note or ED note lacks explicit alignment assessment, making medical necessity unclear
24650 billed same-day as an E/M without modifier 25, triggering NCCI bundle denial
24655 (with manipulation) billed when documentation only supports 24650 (without manipulation), or vice versa
Missing laterality modifier when payer policy requires LT or RT for extremity fracture codes
Global period conflict — follow-up E/M billed within 90 days without modifier 24 by the same provider

Frequently asked questions

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

01Can I bill 24650 if I only applied a sling and gave pain medication — no cast or splint?

Yes, if your note documents that you reviewed imaging, confirmed acceptable fracture alignment, and made a clinical decision for nonoperative management. The treatment decision itself is billable. Document the immobilization choice (including sling) and the rationale explicitly.

02What is the difference between 24650 and 24655?

24650 is closed treatment without manipulation — fracture is in acceptable alignment and you immobilize it as-is. 24655 is closed treatment with manipulation — you physically reposition the fragments before immobilizing. The operative or ED note must clearly state which was performed. Upcoding to 24655 without documented manipulation is a common audit target.

03Can I bill an E/M on the same day as 24650?

Only if the E/M is significant and separately identifiable from the fracture treatment decision. Append modifier 25 to the E/M. Per CMS NCCI policy, the decision to perform a minor surgical procedure is bundled into the procedure payment. A separately documented complaint or problem beyond the fracture is what supports modifier 25.

04Does 24650 have a global period, and what does that cover?

Yes — 90-day global. It includes the day-before and day-of visits, the fracture care, and all routine follow-up through day 90 (cast checks, x-ray interpretation, routine dressing changes). Unrelated procedures in that window need modifier 79; unrelated E/Ms need modifier 24.

05When should I use modifier LT or RT with 24650?

Append LT or RT whenever you're treating a single side and your payer requires laterality for extremity fracture codes — most commercial payers and Medicare contractors do. For bilateral radial head fractures (rare), modifier 50 applies for physician billing; ASC billing uses separate claim lines with LT and RT per CMS NCCI policy.

06Is 24650 appropriate for emergency department physicians, or only orthopedic surgeons?

Any physician who performs the fracture treatment — including ED physicians — can bill 24650. CMS PUF data shows hand surgeons as the top billing specialty, but ED use is common. If the ED physician bills 24650 and transfers post-op care, the receiving orthopedist bills follow-up E/Ms with modifier 24 during the global period.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the fracture site (radial head vs. neck), the imaging-based alignment finding, the explicit statement that no manipulation was performed, and the immobilization type applied — the four elements auditors most commonly find missing when 24650 is challenged. Documenting these in the dictation prevents downcoding to an E/M-only visit and supports the 90-day global period assignment.

See how Mira captures CPT 24650 documentation