Open surgical treatment of a radial head or neck fracture at the elbow, including internal fixation or radial head excision when performed.

Verified May 8, 2026 · 8 sources ↓

Medicare: $622.26
Work RVU: 8.15
Global, days: 90
Region: Elbow

Drawn from CMSGomedicalbillingAAPCFindacodeNIH

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Specify whether internal fixation, radial head excision, or both were performed — the operative note must reflect the actual work done, not a generic descriptor.
Document the fracture classification (e.g., Mason type) and displacement status to support medical necessity for open versus closed management.
Name the surgical approach explicitly (e.g., Kocher, Kaplan, posterolateral) — audit teams flag operative notes that reference only 'standard approach'.
If loose bodies were removed through the same incision, document this in the note but do not bill a separate removal code — it is included in 24665.
Record intraoperative fluoroscopy use, fixation hardware type and size, and final reduction quality to support complete documentation of the procedure.
Confirm fracture ICD-10 code specificity: laterality, initial versus subsequent encounter, and fracture displacement status must align with the claim.

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 51 Multiple procedures 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 24665 covers open treatment of a fracture at the radial head or neck through a surgical incision at the elbow. The surgeon may apply internal fixation hardware (screws or wires) to reduce and stabilize the fracture, excise a portion of the radial head when the fragment is not reconstructable, or perform both steps within the same operative session. Loose body removal is considered included when performed through the same approach — don't stack a separate loose body code expecting separate reimbursement.

This code carries a 90-day global period. All related E/M visits, wound checks, dressing changes, and hardware management through day 90 are bundled. Unrelated E/M services in that window require modifier 24. A return to the OR for a related complication (e.g., hardware failure, wound dehiscence) bills with modifier 78. An unrelated procedure during the global uses modifier 79 — don't invert those two.

NCCI edits bundle 10+ code pairs with 24665, including anesthesia and certain elbow procedure codes. Modifier indicator 0 pairs cannot be unbundled under any circumstance. Indicator 1 pairs may be separately reportable when the operative note documents a distinct anatomic site or separately identifiable service — use modifier XS over the generic modifier 59 when distinct structures justify it.

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 (8.15) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (18.63) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.15
Practice expense RVU	8.84
Malpractice RVU	1.64
Total RVU	18.63
Medicare national rate	$622.26
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	$622.26
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 24665 get rejected.

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

Missing or vague operative note lacking named approach, hardware details, or confirmation of open technique — payers deny without documentation that distinguishes open from closed treatment.
Unbundled billing of a separately coded loose body removal or elbow procedure that NCCI bundles into 24665 under a modifier indicator 0 edit, generating CARC 97 denials.
Post-op E/M visits billed without modifier 24 during the 90-day global period — routine follow-up is bundled and denied without documentation that the visit was for an unrelated condition.
ICD-10 mismatch: using a 'subsequent encounter' (D) diagnosis code on the surgical claim rather than the active treatment (A) encounter code.
Modifier 78 and 79 inversion — billing a related return-to-OR complication with modifier 79 (unrelated) instead of modifier 78 (related) causes payment at incorrect rates or outright denial.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01Is radial head excision billed separately when performed with open ORIF?

No. Radial head excision is included in 24665 when performed at the same operative session. Billing a separate excision code alongside 24665 will generate an NCCI bundling denial.

02Can loose body removal be billed separately if performed through the same incision as 24665?

No. Loose body removal through the same incision is considered integral to the open fracture procedure and is not separately reportable. AAPC forum guidance and lay description summaries confirm this is included in 24665.

03If the same surgeon performs ORIF of a concurrent midshaft ulnar fracture in the same operative session, how should that be coded?

Bill 24665 for the radial head/neck fracture and the appropriate ulnar shaft ORIF code (e.g., 25600-series) with modifier 51 on the secondary code. Because these are distinct fractures at anatomically separate sites, NCCI indicator 1 edits may allow separate billing with modifier 59 or XS if required — check the specific edit pair.

04What modifier applies if the surgeon must return to the OR during the 90-day global to address hardware loosening?

Use modifier 78. That signals an unplanned return to the OR for a complication related to the original procedure. Modifier 79 is reserved for a procedure that is unrelated to the original — do not invert them.

05Does the site of service affect reimbursement for 24665?

Yes, significantly. HOPD and ASC payments differ — see the Site of Service comparison table on this page. The facility versus non-facility distinction also affects the physician's professional fee RVUs, with lower practice expense RVUs applying when the surgeon bills in a facility setting.

06What ICD-10 codes are typically paired with 24665?

Use fracture codes from the S52.0– range (radial head/neck fractures), specifying laterality (1=right, 2=left), displacement status, and the appropriate encounter character — 'A' for initial active surgical treatment. Using a 'D' (subsequent) encounter code on a surgical claim is a common denial trigger.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the surgical approach by name, fixation method (screws, wires, plate), whether radial head excision was performed, intraoperative fluoroscopy use, and fracture classification from the surgeon's dictation. This prevents the most common audit flag for 24665: an operative note that confirms open surgery was performed but fails to document the approach and hardware specifics that distinguish the work from a closed or percutaneous procedure.

See how Mira captures CPT 24665 documentation