Fusion · Elbow

Surgical fusion of the elbow joint using internal fixation and local bone graft harvested from tissue adjacent to the elbow.

Verified May 8, 2026 · 6 sources ↓

Medicare: $780.91
Total RVUs: 23.38
Global, days: 90
Region: Elbow

Drawn from CMSAAPCEatonhandMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Diagnosis driving the arthrodesis (e.g., post-traumatic arthritis, failed elbow arthroplasty, chronic osteomyelitis, tumor) with supporting imaging or prior operative notes
Operative note specifying the surgical approach, extent of joint surface preparation, and fixation construct used
Graft source documented explicitly — local tissue or allograft (24800) versus separate donor-site harvest (24802) — to justify code selection
Desired fusion angle recorded in the operative note; functional position is typically 90 degrees of flexion and neutral rotation
Intraoperative fluoroscopy or imaging findings confirming hardware placement, if obtained
Pre-operative conservative treatment history demonstrating why joint preservation or replacement was not appropriate

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 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 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 24800 covers elbow arthrodesis performed with or without a local autograft or allograft. The surgeon exposes the elbow joint, resects the articular surfaces to create bleeding cancellous bone contact, applies internal fixation hardware to hold the joint in the chosen functional position, and uses locally harvested graft material to stimulate bone bridging across the joint. This is a salvage-level procedure — reserved for end-stage elbow destruction from post-traumatic arthritis, failed total elbow arthroplasty, chronic infection, tumor resection, or irreparable instability where joint reconstruction is no longer viable.

The sister code 24802 covers the same arthrodesis but with autograft obtained from a separate donor site (e.g., iliac crest). Bill 24800 only when graft is local or allograft; switch to 24802 when the surgeon harvests bone from a distinct anatomic site through a separate incision. Conflating the two is one of the most common coding errors for this procedure.

The 90-day global period means all routine follow-up, hardware checks, cast or splint management, and wound care through day 90 are bundled into the surgical payment. Any E&M service on the day of surgery to decide whether to operate requires modifier 57. Unrelated procedures or new injuries managed during the global window need modifier 79.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	11.12
Practice expense RVU	9.89
Malpractice RVU	2.37
Total RVU	23.38
Medicare national rate	$780.91
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	$780.91
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 24800 get rejected.

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

Code billed as 24800 when graft was harvested from a separate donor site — should be 24802
Medical necessity not supported: insufficient documentation of failed prior treatment or end-stage joint pathology
Global period violations — post-op E&M claims submitted without modifier 24 for unrelated conditions
Missing or vague operative note language around graft source, fixation method, or approach name
Improper modifier 57 usage — decision-for-surgery E&M billed on date of service without the modifier, triggering bundling denial

Frequently asked questions

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

01What is the difference between CPT 24800 and 24802?

24800 covers elbow arthrodesis with local or allograft material — bone taken from tissue immediately adjacent to the elbow or from a bone bank. 24802 is used when the surgeon harvests autograft from a separate anatomic site, such as the iliac crest, through a distinct incision. The operative note must specify graft source clearly to defend whichever code you bill.

02Can you bill a same-day E&M with CPT 24800?

Only with the right modifier. If the E&M on the day of surgery represented the decision to operate, append modifier 57. Routine pre-op assessment on the same date is bundled into the global and not separately billable. Unrelated E&M services during the 90-day global require modifier 24.

03What modifier applies if a complication requires a return to the OR during the global period?

Modifier 78 for an unplanned return to the OR for a procedure directly related to the original arthrodesis (e.g., hardware failure, wound dehiscence requiring surgical management). Use modifier 79 for a procedure that is unrelated to the elbow fusion.

04Is elbow arthrodesis ever performed bilaterally?

Bilateral elbow arthrodesis is exceedingly rare clinically, but if performed, append modifier 50 and follow payer-specific bilateral payment rules. Most payers will require documentation of separate medical necessity for each side.

05What ICD-10 diagnoses most commonly support 24800?

Post-traumatic elbow arthritis (M19.021/M19.022), failed total elbow arthroplasty (T84.098A or appropriate complication code), chronic osteomyelitis of the humerus or ulna, and elbow instability following ligamentous or bony destruction. The diagnosis must match the documented clinical picture — generic 'elbow pain' codes will not clear medical necessity review for a salvage procedure.

06Does CPT 24800 include intraoperative fluoroscopy?

Intraoperative imaging used for guidance during the arthrodesis is generally bundled into the surgical code and not separately billable. Standalone diagnostic radiographs obtained at a distinct time for a distinct purpose may be billable separately with appropriate documentation.

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 approach name, graft source (local vs. separate donor site), fixation hardware type, and the documented fusion angle from dictation — the three variables auditors check first on elbow arthrodesis claims. Explicit graft-source language in the operative note is what separates a clean 24800 from a 24802 coding error or a medical necessity denial.

See how Mira captures CPT 24800 documentation