Amputation of the upper arm through the humeral shaft with insertion of a prosthetic implant to preserve limb length or facilitate future prosthetic fitting.

Verified May 8, 2026 · 6 sources ↓

Medicare: $858.07
Total RVUs: 25.69
Global, days: 90
Region: Elbow

Drawn from CMSAAPCCgsmedicareEmedny

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 specify the exact level of humeral transection (proximal, mid-shaft, or distal third).
Document implant type, manufacturer, lot number, and the clinical rationale for implant placement (limb length preservation vs. prosthetic preparation).
Confirm whether procedure is primary amputation or revision of a prior amputation — payers distinguish these and may request prior operative records.
Record the indication (trauma, malignancy, infection, vascular compromise) with supporting ICD-10 diagnosis codes that map to the procedure.
Document neuroma management if nerves were addressed — additional neurectomy codes may apply and require separate note entries.
Anesthesia type and intraoperative findings should be present to support medical necessity if payer requests records.

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 52 Reduced services 58 Staged or related 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 24931 describes a transhumeral amputation — complete surgical division of the humerus at any level — combined with implant placement. The implant maintains the residual limb's functional length and creates a stable platform for eventual prosthetic fitting. This distinguishes 24931 from non-implant upper arm amputations (24900–24920), which carry no implant component.

The 90-day global period covers the operative day, any same-day pre-operative E/M, and all routine post-operative management through day 90. Separate billing for wound checks, suture removal, or routine residual limb shaping within that window is not payable without modifier 24 (unrelated E/M) or 79 (unrelated procedure). Complications requiring a return to the OR for a related procedure use modifier 78.

This code appears in the upper arm and elbow amputation subsection (24900–24931 range) and is grouped with 24925–24930 (revision procedures) and 24935 (stump elongation). When an amputation revision with implant is performed rather than a primary amputation, code selection and documentation must clearly distinguish the clinical scenario to avoid downcoding or bundling errors.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	13.1
Practice expense RVU	9.81
Malpractice RVU	2.78
Total RVU	25.69
Medicare national rate	$858.07
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	$858.07
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$9,493.97

Common denial reasons

The recurring reasons claims for CPT 24931 get rejected.

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

Missing or vague implant documentation — payers deny when the operative note does not name the device or justify its use.
ICD-10 mismatch — diagnosis codes reflecting a condition not consistent with amputation level or laterality trigger automatic edits.
Global period bundling — post-op visits billed without modifier 24 or 79 deny when payer identifies the 90-day global window.
Bilateral billing errors — upper arm amputations are rarely bilateral, but missing LT/RT modifiers on any unilateral claim causes routing confusion and denial.
Upcoding flag when prior amputation history is not disclosed — payers may reclassify to a revision code (24925–24930) if records suggest a staged or repeat procedure.

Frequently asked questions

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

01What separates 24931 from 24900–24920?

The implant. Codes 24900–24920 cover upper arm amputations without an implant component. 24931 requires both the transhumeral amputation and placement of an implant to preserve limb length or support prosthetic fitting. If no implant is placed, use the appropriate non-implant code.

02Can 24931 and a neurectomy code be billed together?

Yes, if the nerve was addressed as a distinct procedure with its own documentation — for example, traction neurectomy to prevent neuroma formation. Bill the neurectomy separately with modifier 59 or XS and ensure the operative note addresses the nerve work independently. Review current NCCI PTP edits for the specific neurectomy code pairing before submitting.

03How does the 90-day global period affect post-op prosthetic evaluations?

Routine prosthetic check visits by the operating surgeon within 90 days are bundled into the global. If a physiatrist or separate provider handles prosthetic management, their services bill under their own NPI and are not subject to the surgeon's global period. If the surgeon provides prosthetic-related E/M unrelated to the amputation surgery itself, modifier 24 applies.

04What modifier applies if the patient returns to the OR for wound dehiscence at the residual limb within the global period?

Modifier 78 — unplanned return to the OR for a complication related to the original procedure. Use 79 only if the return procedure is clinically unrelated to the amputation. Inverting these modifiers is a common audit finding.

05Is prior authorization typically required for 24931?

In trauma or urgent cases, most payers accept retroactive authorization. For elective oncologic or dysvascular amputations, commercial payers and Medicare Advantage plans commonly require prior authorization. Confirm payer-specific requirements before scheduling — policies vary by plan and are not standardized across Medicare Fee-for-Service, Medicare Advantage, or Medicaid.

06Should LT or RT modifier be appended?

Yes. Upper arm amputation is a unilateral procedure. Always append LT or RT. Missing laterality is a clean-claim failure point and a common edit trigger in both Medicare and commercial adjudication.

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 humeral transection level, implant name and lot number, nerve handling (including any neurectomy), and the clinical indication driving the amputation from surgeon dictation. That specificity prevents the two most common denial triggers for 24931: a vague operative note that omits implant justification and an ICD-10 mismatch between documented pathology and the procedure performed.

See how Mira captures CPT 24931 documentation