Open surgical treatment of a fracture at the proximal ulna — olecranon or coronoid process — with internal fixation when performed.

Verified May 8, 2026 · 6 sources ↓

Medicare: $622.26
Work RVU: 8.16
Global, days: 90
Region: Elbow

Drawn from CMSAbosAAOSAAPC

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the fracture location by name: olecranon, coronoid process, or both — do not use generic language like 'proximal ulna fracture' without anatomic detail.
Document the fixation construct used (e.g., plate and screws, tension-band wiring, suture anchor) — internal fixation is included in 24685 but must appear in the operative note to justify the code.
If billing 24685 twice for olecranon and coronoid fractures treated in the same session, the operative note must describe each fracture's reduction and fixation as a distinct step.
Confirm radial head status: document whether the radial head is dislocated. If it is, 24635 (Monteggia) may be the correct code, not 24685.
Record laterality (left or right elbow) in both the operative report and the diagnosis codes to support LT or RT modifier on the claim.
Note neurovascular status pre- and post-reduction, particularly ulnar nerve assessment, since ulnar nerve transposition performed in the same session has separate coding implications subject to NCCI edits.

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 57 Decision for surgery 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 24685 covers open reduction of fractures at the proximal end of the ulna, including olecranon fractures and coronoid process fractures. Internal fixation (plates, screws, tension-band constructs) is included in the code when performed — it is not separately billable. The 90-day global period means all routine post-op care from the day before surgery through day 90 is bundled; any E/M visit during that window for an unrelated problem requires modifier 24, and a decision-for-surgery visit the day before requires modifier 57.

When both the olecranon and coronoid are fractured and each requires distinct open fixation, billing 24685 twice with modifier 59 (or its X-subset modifiers) on the second unit is common practice — but document each fracture's fixation separately in the operative note. For a true Monteggia pattern (proximal ulna fracture plus radial head dislocation), 24635 is the more specific code; 24685 is the correct choice when the radial head is not dislocated or when the injury is isolated to the olecranon or coronoid. Mixing 24685 and 24635 on the same claim requires careful NCCI PTP edit review, as bundling edits apply.

Site of service matters here: the HOPD facility payment is substantially higher than the ASC rate. The surgeon's professional fee is the same regardless of site, but the facility choice affects the patient's cost-sharing and the facility's reimbursement — a factor when scheduling elbow trauma cases.

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 (8.16) 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	8.16
Practice expense RVU	8.8
Malpractice RVU	1.67
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 J8) Ambulatory surgical center (freestanding)	$4,719.21

Common denial reasons

The recurring reasons claims for CPT 24685 get rejected.

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

Billing 24685 when operative note describes a Monteggia fracture-dislocation — payers expect 24635 for combined ulna fracture plus radial head dislocation.
Duplicate billing of 24685 without modifier 59 when olecranon and coronoid fractures are each fixed — the second unit is denied as a duplicate without a distinct-service modifier.
Missing laterality modifier (LT or RT) triggering claim suspension or denial on government and many commercial payers.
Separately billing internal fixation hardware codes or reduction services already included in 24685 — these are bundled and denied under NCCI PTP edits.
E/M services billed during the 90-day global period without modifier 24 (unrelated) or 57 (decision for surgery) are denied as included in the global surgical package.

Frequently asked questions

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

01When should I use 24685 vs. 24635 for a proximal ulna fracture?

Use 24635 when the radial head is also dislocated (Monteggia pattern). Use 24685 when the fracture is isolated to the olecranon or coronoid without radial head dislocation. The operative note must document radial head status to support whichever code you bill.

02Can I bill 24685 twice if I fixed both the olecranon and coronoid in the same surgery?

Yes, when each fracture required distinct open fixation. Append modifier 59 (or XS) to the second unit and document each fracture's reduction and fixation as a separate operative step. Billing two units without a modifier will result in denial of the second unit as a duplicate.

03Is internal fixation separately billable when performed with 24685?

No. Internal fixation is included in 24685 when performed. Billing additional hardware or fixation codes on top of 24685 will be denied under NCCI bundling rules.

04Can I bill ulnar nerve transposition (64718) at the same time as 24685?

This is payer-dependent. NCCI PTP edits bundle 64718 as a column 2 code with certain elbow fracture codes. Check current NCCI edit tables for the 24685/64718 pair specifically. AAOS Global Service Data may indicate it is separately reportable, but most payers follow NCCI, so modifier 59 does not guarantee payment — verify with the specific payer before billing.

05What modifier applies if I operate on the same elbow again during the 90-day global for a related complication?

Use modifier 78 for an unplanned return to the OR for a complication related to the original procedure. Modifier 79 is for an unrelated procedure in the global period. Do not invert these — using 79 for a complication-related return is an audit flag.

06Does 24685 carry a 90-day global period, and what does that cover?

Yes, 24685 has a 90-day global period. That covers the day-before visit, the surgery itself, and all routine post-op care through day 90 — including office visits, splint/cast changes, and suture removal. Bill unrelated E/M services in that window with modifier 24; the decision-for-surgery visit requires modifier 57.

07Which laterality modifier applies, and is it required?

Use LT for left elbow, RT for right elbow. Medicare and most commercial payers require laterality on unilateral procedure claims. Missing this modifier is a common cause of claim suspension or denial.

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 by anatomic name (olecranon vs. coronoid vs. both), the fixation construct applied, radial head status, and laterality directly from the surgeon's dictation. That specificity prevents the most common audit flag for 24685 — operative notes that describe the procedure generically enough to support 24635 (Monteggia) instead, triggering downcoding or a request for records.

See how Mira captures CPT 24685 documentation