Surgical removal of the upper arm by transection through the humerus, with wound closure using remaining muscle and skin layers.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $720.12
- Total RVUs
- 21.56
- Global, days
- 90
- Region
- Shoulder
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 5 cited references ↓
- Operative note must specify the exact level of transection on the humerus — proximal, mid-shaft, or distal — not just 'through humerus'
- Document the indication: trauma, vascular occlusion, malignancy, or infection, with supporting clinical findings
- Record that limb-salvage alternatives were considered and found unsuitable or previously failed
- Laterality must be explicitly stated — left or right upper arm — to support LT or RT modifier
- If modifier 22 is appended, the operative note must quantify the increased complexity: contamination level, extended operative time, aberrant anatomy, or prior surgical changes
- Vascular and nerve ligation levels should be named in the operative report to support completeness of service
- Post-operative note at each global-period visit must distinguish routine wound care (bundled) from new or unrelated problems (separately billable)
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 5 cited references ↓
CPT 24900 describes amputation of the upper arm at any level through the humerus. The surgeon divides bone, muscle, nerves, and vascular structures at the chosen level, then fashions a residual limb by closing the wound with available soft tissue. Indications include severe trauma, vascular compromise, malignancy, or uncontrolled infection that makes limb salvage impossible or unsafe.
The code carries a 90-day global period. Routine post-operative visits, dressing changes, and wound management within that window are bundled — bill separately only for distinct, unrelated services using modifier 24. Laterality modifiers LT and RT are required; modifier 50 applies only in the rare bilateral scenario. If the complexity of dissection, contamination, or patient condition substantially increased operative time and effort, modifier 22 requires a written explanation in the operative note.
Site of service matters significantly here: HOPD and ASC payment rates differ considerably (see the Site of Service comparison table). Most payers require prior authorization for elective amputations and may request clinical documentation establishing medical necessity — including evidence that limb-salvage alternatives were evaluated and found unsuitable.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 9.93 |
| Practice expense RVU | 9.52 |
| Malpractice RVU | 2.11 |
| Total RVU | 21.56 |
| Medicare national rate | $720.12 |
| 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 | $720.12 |
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 24900 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing laterality modifier — claims submitted without LT or RT are routinely rejected by Medicare and most commercial payers
- Medical necessity denial when documentation does not demonstrate failed or contraindicated limb-salvage alternatives
- Global period violations — billing E/M or wound care visits within the 90-day global without modifier 24 triggers automatic bundling denials
- Prior authorization absent for elective cases — many payers require authorization before scheduling non-emergent amputation
- Modifier 22 denied when operative note lacks specific documentation of the increased complexity; a vague statement of 'difficult case' is insufficient
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01Does CPT 24900 require a laterality modifier?
02What is the global period for 24900, and what does it cover?
03When should modifier 22 be appended to 24900?
04Is CPT 24920 ever more appropriate than 24900?
05Does prior authorization apply to CPT 24900?
06Can the assisting surgeon bill separately for 24900?
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 amputation level on the humerus, the clinical indication, vascular and nerve ligation details, wound closure technique, and explicit laterality from dictation. It flags when the operative note omits a limb-salvage consideration statement — the absence of that language is the most common trigger for medical necessity denials on pre-authorization reviews and post-payment audits.
See how Mira captures CPT 24900 documentation