Surgical fusion of the elbow joint using bone graft harvested from the patient's own body, with internal fixation to eliminate motion and stabilize the joint.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $926.54
- Total RVUs
- 27.74
- Global, days
- 90
- Region
- Elbow
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 6 cited references ↓
- Operative note must name the graft harvest site (e.g., ipsilateral iliac crest) and confirm autogenous graft use — 'autograft' alone without harvest site detail is an audit flag
- Document the specific fusion position in degrees of flexion and forearm rotation; 'functional position' without numeric values is insufficient
- Record the fixation construct used (plate, screws, intramedullary device) with implant details for implant cost reporting and audit defense
- Pre-operative imaging (radiograph or CT) confirming the joint pathology that necessitated arthrodesis over reconstruction or replacement
- Medical necessity narrative explaining why arthroplasty was not appropriate — payers increasingly require this for elbow arthrodesis given the availability of total elbow replacement
- Document the primary diagnosis driving the procedure (e.g., post-traumatic arthritis, failed prior arthroplasty, chronic septic arthritis) with supporting ICD-10 codes linked on the claim
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 6 cited references ↓
CPT 24802 covers elbow arthrodesis performed with an autogenous graft — meaning the surgeon harvests bone from another site on the same patient (commonly the iliac crest) and uses it to induce fusion across the elbow joint. Harvesting the graft is bundled into this code; do not separately report a bone graft harvest code. Internal fixation devices are placed to hold the joint in the chosen position while fusion consolidates. The code sits one step above 24800 (elbow arthrodesis without autograft or with local graft only) — the distinction between these two codes hinges on the graft source and harvest site.
Elbow arthrodesis is a salvage procedure reserved for cases where joint reconstruction or replacement has failed, is contraindicated, or where chronic infection, severe post-traumatic arthritis, or flail elbow makes fusion the only viable option. Because it permanently eliminates elbow flexion-extension, the functional position chosen for fusion — typically 90 degrees of flexion with neutral rotation — must be documented explicitly in the operative note.
The 90-day global period applies. All routine post-op visits, hardware checks, and wound care through day 90 are bundled. Use modifier 24 for unrelated E/M visits during the global period and modifier 78 for unplanned returns to the OR for a related complication (e.g., fixation failure). Modifier 79 covers unrelated OR returns in the same global window.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 13.96 |
| Practice expense RVU | 10.8 |
| Malpractice RVU | 2.98 |
| Total RVU | 27.74 |
| Medicare national rate | $926.54 |
| 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 | $926.54 |
HOPD (APC 5115) Hospital outpatient department | $13,116.76 |
ASC (PI G2) Ambulatory surgical center (freestanding) | $6,804.43 |
Common denial reasons
The recurring reasons claims for CPT 24802 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Lack of medical necessity documentation — payers may require evidence that joint reconstruction or total elbow replacement was considered and ruled out before approving arthrodesis
- Upcoding concern when 24802 is billed but the operative note describes only local bone or no separate graft harvest, which maps to 24800 instead
- Separate billing of bone graft harvest codes alongside 24802 — graft harvest is included in this code and will trigger an NCCI bundling denial
- Missing or non-specific ICD-10 diagnosis code that does not justify a salvage-level procedure like permanent joint fusion
- Global period conflicts when post-op E/M visits are billed without modifier 24 and are flagged as bundled into the 90-day global
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What is the difference between 24800 and 24802?
02Can I separately bill for bone graft harvesting with 24802?
03What global period applies to 24802, and what does that mean for post-op billing?
04Is prior authorization typically required for 24802?
05What ICD-10 codes are typically paired with 24802?
06Can 24802 be billed with a co-surgeon using modifier 62?
07How does site of service affect reimbursement for 24802?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02aapc.comhttps://www.aapc.com/codes/cpt-codes/24802
- 03cms.govhttps://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-policy-manual
- 04bedrockbilling.comhttps://bedrockbilling.com/static/cci/24802
- 05findacode.comhttps://www.findacode.com/cpt/24802-cpt-code.html
- 06eatonhand.comhttp://www.eatonhand.com/coding/cpt30a.htm
Mira AI Scribe
Mira's AI scribe captures the graft harvest site by name, the fusion position in degrees, the fixation construct, and the clinical rationale for arthrodesis over arthroplasty — directly from surgeon dictation. That prevents the two most common downcodes: a missing harvest site that collapses 24802 to 24800, and a vague medical necessity note that triggers a payer medical necessity denial.
See how Mira captures CPT 24802 documentation