CPT 24006 Elbow Repair Reimbursement | OpenPayer

Summary & Overview

CPT 24006: Elbow Repair for Recurrent Dislocation and Osteochondritis Dissecans

CPT code 24006 denotes a surgical procedure to repair the elbow joint for recurrent dislocation and osteochondritis dissecans (OCD). This code captures operative management aimed at restoring elbow stability and treating intra-articular lesions that can lead to recurrent instability and joint degeneration. It is relevant nationally for surgeons, surgical facilities, and payers because it relates to specialized orthopedic care that may involve hospital or ambulatory surgery center resources and variable reimbursement pathways.

Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of clinical indications and typical settings for CPT code 24006, an outline of common modifiers and billing considerations, and what to expect in payer coverage and documentation requirements. The publication also highlights benchmarking elements and policy considerations that affect authorization, site-of-service decisions, and coding precision.

This summary is intended to orient clinicians, billing staff, and policy analysts to the code’s clinical purpose, operational context, and the types of analyses—benchmarks, policy updates, and clinical context—that follow in the full publication. Data not available in the input will be noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 24006elbow repairorthopedic surgeryosteochondritis dissecansrecurrent dislocationsurgical codingambulatory surgeryhospital billing

Billing Code Overview

CPT code 24006 describes a surgical repair of the elbow joint performed to treat recurrent dislocation and osteochondritis dissecans (OCD). The procedure involves operative intervention to restore joint stability and address intra-articular pathology associated with OCD, which may include debridement, fixation, or reconstruction as indicated by the intraoperative findings.

Service type: Surgical — Open or arthrotomy elbow repair for instability/OCD

Typical site of service: Hospital inpatient or outpatient surgical center; operating room

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 16-year-old adolescent male presents with recurrent lateral elbow instability and persistent elbow pain after multiple episodes of elbow subluxation and a prior history of osteochondritis dissecans (OCD) of the capitellum. Conservative treatment including activity modification, physical therapy, and intermittent splinting failed to restore stability and alleviate symptoms. Imaging (radiographs and MRI) demonstrates fragmentation consistent with OCD and recurrent posterolateral rotatory instability with loose bodies. The orthopedic surgeon schedules an operative intervention for open or arthrotomy-assisted repair of the elbow joint to address recurrent dislocation and treatment of OCD, which may include loose body removal, chondral fragment fixation or debridement, and ligamentous repair/reconstruction.

The typical clinical workflow includes preoperative evaluation with focused elbow exam, neurovascular assessment, and imaging review; preoperative anesthesia evaluation; intraoperative arthroscopic or open assessment of the capitellum and ulnohumeral joint; removal or fixation of osteochondral fragments; repair or reconstruction of damaged ligamentous stabilizers (often lateral collateral ligament complex); hemostasis and wound closure; and postoperative immobilization followed by a staged rehabilitation plan to restore range of motion and strength.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the physician’s professional component for a diagnostic or therapeutic service if applicable to imaging or interpretation services billed separately.

CPT 23935: Upper Arm/Elbow Bone Decompression for Osteomyelitis or Abscess

CPT-23930-DEEP-INCISION-DRAINAGE-UPPER-ARM-ELBOW

CPT 23930: Incision and Drainage of Deep Upper Arm/Elbow Abscess

CPT-24000-ELBOW-JOINT-EXPLORATION-REMOVAL-LOOSE-BODIES

CPT 24000: Open Elbow Joint Exploration and Removal of Loose Bodies

CPT-23931-SHOULDER-ELBOW-BURSA-INCISION-DRAINAGE

CPT 23931: Incision and Drainage of Upper Arm/Elbow Bursa

Taxonomy Code	Specialty	Notes
207X00000X	Orthopaedic Surgery	Primary specialty performing elbow reconstructive procedures and OCD management.
207LA0202X	Sports Medicine (Orthopaedics)	Subspecialists who frequently manage traumatic instability and cartilage injuries in athletes.
207K00000X	Hand Surgery (Orthopaedics)	Elbow specialists with additional focus on upper extremity reconstructive procedures.
208800000X	Physical Medicine & Rehabilitation	Clinicians involved in postoperative rehabilitation planning and nonoperative management prior to surgery.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M24.211`	Recurrent dislocation, right elbow	Directly indicates recurrent elbow dislocation treated by surgical repair.
`M24.212`	Recurrent dislocation, left elbow	As above for left-sided procedures.
`M93.41`	Osteochondritis dissecans, right elbow	Specifies OCD pathology of the elbow contributing to loose bodies and joint damage.
`M93.42`	Osteochondritis dissecans, left elbow	As above for left-sided OCD.
`S53.0XXA`	Dislocation of elbow joint, initial encounter	Acute dislocation events often in the history leading to recurrent instability; useful when coding acute-on-chronic presentations.
`M25.81`	Other specified joint disorder, elbow	Use when coding non-specific degenerative or post-traumatic joint pathology contributing to symptoms.
`M67.821`	Loose body in joint, right elbow	Indicates presence of intra-articular loose bodies often removed during the procedure.
`M67.822`	Loose body in joint, left elbow	As above for the left elbow.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`29830`	Arthroscopy, elbow, diagnostic, with/without synovial biopsy	Diagnostic arthroscopy may be performed preoperatively or intraoperatively to evaluate joint surfaces and loose bodies prior to or instead of open repair.
`29834`	Arthroscopy, elbow, debridement, partial synovectomy	Arthroscopic debridement of degenerative or inflammatory tissue often accompanies OCD treatment or loose body removal.
`24250`	Open treatment of intra-articular fracture, elbow; with internal fixation	Performed when OCD or instability is associated with osteochondral fractures requiring internal fixation.
`24345`	Repair of ulnar collateral ligament, elbow (repair, reconstruction)	Ligament repair or reconstruction codes used when reconstruction of stabilizing ligaments is necessary for recurrent dislocation.
`20670`	Removal of deep implant; deep foreign body	Removal of symptomatic loose bodies or retained implants encountered during surgery.
`99024`	Postoperative follow-up visit globally (often payer-specific)	Used for routine postoperative visits during the global surgical period as applicable per payer policy.

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