Closed treatment of a radial head or neck fracture at the elbow, requiring manual manipulation to realign the fracture fragments, followed by splint or cast application to maintain reduction.

Verified May 8, 2026 · 6 sources ↓

Medicare: $532.74
Work RVU: 4.5
Global, days: 90
Region: Elbow

Drawn from CMSAAPCEatonhandAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Fracture location specified as radial head or radial neck — not just 'proximal radius' — with imaging correlation
Explicit documentation that manipulation (manual reduction) was performed, not just immobilization
Pre- and post-reduction alignment or angulation noted, ideally with fluoroscopy or radiograph findings cited in the operative note
Laterality documented clearly (left or right elbow) to support LT/RT modifier
Type of immobilization applied after reduction (long-arm splint, posterior splint, cast) and position of forearm and elbow
Neurovascular status of the extremity assessed and recorded before and after manipulation

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 50 Bilateral procedure 52 Reduced services 57 Decision for surgery 58 Staged or related 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 24655 covers closed (non-operative) fracture management of the radial head or neck where the surgeon manually reduces a displaced or angulated fracture and immobilizes the elbow. The distinction from 24650 is manipulation — if the fracture required hands-on reduction, 24655 is correct; if it was non-displaced and treated with immobilization only, 24650 applies. Splint or cast application is bundled into this code and not separately billable.

The 90-day global period includes the day-before visit, the procedure day, and all routine post-op care through day 90. Follow-up visits for fracture healing checks, cast changes, and splint adjustments are all bundled. Bill an unrelated E/M during the global with modifier 24. A staged or planned return procedure (e.g., eventual ORIF if closed reduction fails) uses modifier 58; an unplanned return for a related complication uses modifier 78.

Side-specific billing is standard: append LT or RT based on the operative side. When bilateral radial head fractures are treated at the same session — uncommon but possible — append modifier 50 and verify payer policy, as some payers require separate line items with LT/RT instead.

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 (4.5) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (15.95) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.5
Practice expense RVU	10.42
Malpractice RVU	1.03
Total RVU	15.95
Medicare national rate	$532.74
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	$532.74
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 24655 get rejected.

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

Billed as 24655 when operative note describes immobilization only with no manipulation — correct code is 24650
Missing or incorrect laterality modifier (LT/RT) required by Medicare Advantage and many commercial payers
Separate billing for splint or cast application (29105, 29125, 29126) on the same date — those are bundled into 24655
ICD-10 diagnosis code does not specify radial head or neck fracture (e.g., generic S52 without appropriate 7th-character extension for initial encounter)
Post-op E/M visits billed without modifier 24 during the 90-day global period, triggering automatic denial

Frequently asked questions

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

01What's the difference between 24650 and 24655?

Manipulation. 24650 is for radial head or neck fractures treated with immobilization only — no hands-on reduction. 24655 requires documented manual reduction of the fracture before immobilization. If your note doesn't explicitly describe manipulation, auditors will downcode to 24650.

02Can I separately bill for the splint or cast applied after reduction?

No. Cast and splint application is bundled into 24655. Billing 29105, 29125, or 29126 on the same date will be denied as mutually inclusive with the fracture care code.

03How do I bill a follow-up visit during the 90-day global if it's for an unrelated condition?

Append modifier 24 to the E/M code and document clearly that the visit was for a condition unrelated to the radial head fracture. The medical record must support a distinct chief complaint, assessment, and plan separate from fracture follow-up.

04What if closed reduction fails and the patient needs open reduction later?

Bill the subsequent ORIF (24665 or 24666) with modifier 58 to indicate a staged or planned procedure during the global period. Modifier 58 resets the global clock. Do not use modifier 78, which is for unplanned returns for related complications.

05Is fluoroscopy separately billable when used to confirm reduction?

Per NCCI policy, fluoroscopy used as guidance during a fracture reduction procedure is generally considered integral. Do not separately bill fluoroscopy codes for intraoperative imaging used solely to confirm reduction alignment during this procedure.

06Which ICD-10 codes are required for a clean claim?

Use S52.001A–S52.009A for radial head fractures or S52.011A–S52.019A for radial neck fractures at initial encounter (7th character A). Subsequent encounter uses D; sequela uses S. Payers routinely deny claims where the 7th character doesn't match the episode of care.

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 pattern (radial head vs. neck), the degree of displacement or angulation on pre-reduction imaging, the specific manipulation technique performed, post-reduction alignment, and the type and position of immobilization applied. It also flags laterality in real time. This prevents the most common denial: a note that describes the injury and the cast but omits any documentation of the manual reduction step — the element that separates 24655 from 24650.

See how Mira captures CPT 24655 documentation