Open treatment of a radial head or neck fracture, including internal fixation or radial head excision when performed, with prosthetic replacement of the radial head.

Verified May 8, 2026 · 6 sources ↓

Medicare: $685.05
Total RVUs: 20.51
Global, days: 90
Region: Elbow

Drawn from AAPCKzanowMdclarityGenhealthCMS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify fracture pattern and location (radial head vs. neck) with imaging correlation — X-ray and/or CT findings should be referenced in the operative note.
Document the decision to proceed with prosthetic replacement rather than ORIF, including clinical rationale (e.g., comminution, bone quality, fracture classification).
Name the implant used: manufacturer, model, size, and lot number for implant log and payer audit trail.
Describe the surgical approach by name (e.g., Kocher lateral, Kaplan) — notes that read 'standard lateral approach' are audit flags.
Confirm whether internal fixation was attempted prior to the decision to replace; document excision of radial head fragments if performed.
Record intraoperative fluoroscopy use and confirm prosthetic sizing and alignment before wound closure.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 24666 covers open surgical treatment of a radial head or neck fracture where the surgeon places a prosthetic radial head implant. The code bundles the fracture exposure, any internal fixation attempted, radial head excision if performed, and the prosthetic implantation into a single billable unit. It applies specifically to acute fracture cases — not to chronic degenerative conditions or failed prior arthroplasty, which fall under 24366.

A critical bundling rule: the lateral collateral ligament complex and annular ligament must be released to access the radial head during implantation. Even when those structures are torn by the fracture and surgically repaired, the repair (e.g., CPT 24343) is included in 24666 per AAOS Global Service Data. Billing 24343 alongside 24666 for the same encounter is inappropriate. Similarly, 24666 and 24366 cannot be billed together — they describe the same operative construct for different clinical indications; pick the one that matches the documented presentation.

The 90-day global period covers all routine post-op care, dressing changes, and standard follow-up visits through day 90. Use modifier 24 for unrelated E/M services and modifier 78 for an unplanned return to the OR for a related complication within the global window. For a repeat implant procedure by the same surgeon — such as revision of a previously placed radial head prosthesis — append modifier 76.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.61
Practice expense RVU	8.95
Malpractice RVU	1.95
Total RVU	20.51
Medicare national rate	$685.05
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	$685.05
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$9,673.31

Common denial reasons

The recurring reasons claims for CPT 24666 get rejected.

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

Unbundling: billing 24343 (lateral collateral ligament repair) or 24366 (radial head arthroplasty) alongside 24666 for the same session — all are included.
Indication mismatch: using 24666 for chronic degenerative or non-fracture indications, which map to 24366 instead.
Global period conflict: billing routine post-op E/M visits within the 90-day global without modifier 24, triggering automatic denial.
Missing implant documentation: payers require implant name, size, and lot number to process claims involving prosthetic components.
Laterality absent: claims missing LT or RT modifier are rejected by many payers as insufficiently specific for a unilateral elbow procedure.

Frequently asked questions

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

01Can I bill 24666 and 24366 together when the surgeon both treats the fracture and performs an arthroplasty?

No. The two codes describe the same operative construct for different indications — 24666 is for acute fracture, 24366 is for chronic or non-fracture conditions. Bill whichever matches the documented clinical scenario. Billing both together will be denied as duplicate.

02The surgeon also repaired the lateral collateral ligament during the same session. Can I add 24343?

No. Per AAOS Global Service Data, lateral collateral ligament repair (24343) is included in 24666. The LCL must be released to perform the radial head insertion, and its repair — even when the fracture tore it — is bundled. Adding 24343 constitutes inappropriate unbundling.

03The patient had a prior radial head prosthesis placed and is now returning for revision. Does 24666 still apply?

24666 applies if the revision involves open treatment in the fracture-care context. For a straight implant exchange without an acute fracture, 24366 may be the better fit. If the same surgeon is repeating 24666 for the same side, append modifier 76. If a different surgeon performs it, use modifier 77.

04What modifier applies if the surgeon performs an unrelated elbow procedure during the 90-day global period?

Use modifier 79 (unrelated procedure by the same physician during the postoperative period). Do not use modifier 78 — that modifier is reserved for an unplanned return to the OR for a procedure related to the original surgery.

05Is 24666 ever billed with modifier 50 for bilateral procedures?

Bilateral radial head fractures are rare but not impossible. If both elbows are treated in the same session, modifier 50 applies. Most payers will reduce the second side by 50%. In practice, LT and RT are more commonly used than 50 for bilateral elbow claims — confirm payer preference before submitting.

06Does the global period apply differently at an ASC versus a hospital outpatient department?

The 90-day global period is a professional fee rule and applies regardless of facility setting. The facility payment rates differ (see the Site of Service comparison on this page), but the global bundling of post-op professional services is the same whether the case is done at an HOPD or ASC.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the fracture classification, surgeon's stated rationale for prosthetic replacement over ORIF, implant details (name, size, lot), approach nomenclature, and whether ligament structures were divided or repaired during access. This prevents the two most common audit flags for 24666: vague approach documentation and missing implant specificity that triggers payer requests for additional records.

See how Mira captures CPT 24666 documentation