Summary & Overview
CPT 24116: Excision of Humerus Bone Lesion with Donor Bone Graft
CPT code 24116 covers surgical excision of a bone cyst or benign tumor from the humerus with removal of the involved bone and placement of donor bone graft to fill the defect. This procedure is clinically significant because it addresses structural bone defects and prevents fracture or recurrence by removing pathology and restoring bone integrity. Nationally, procedures like this carry implications for surgical resource use, inpatient versus outpatient care patterns, and graft utilization.
Key payers considered in this context include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical indications and typical sites of service, along with benchmarking and policy-relevant content where available. The publication summarizes common billing considerations, typical payer coverage patterns, and where to look for updates in coding guidance and reimbursement policy. It also outlines the clinical context for the procedure, including goals of excision and grafting and expected care settings.
Data not available in the input includes payer-specific rates, associated taxonomies, and ICD-10 diagnosis pairings. The piece is intended for national audiences seeking a clear, practical synopsis of CPT code 24116’s clinical meaning and billing context.
Billing Code Overview
CPT code 24116 describes a surgical procedure in which a provider excises a bone cyst or benign (noncancerous) tumor from the humerus. The procedure includes removal of the portion of the humeral bone on which the lesion has grown and filling the resulting defect with graft material sourced from a donor.
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Service type: Surgical excision and bone grafting of the humerus
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Typical site of service: Hospital operating room or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A 22-year-old ambulatory patient presents with progressive, localized pain and a palpable swelling of the proximal humerus. Imaging (plain radiographs and MRI) demonstrates an expansile, lytic bone lesion consistent with a benign unicameral bone cyst (simple bone cyst) without radiographic signs of malignancy. After orthopedic oncology consultation, the plan is surgical excision and curettage of the cyst with partial resection of the involved cortical bone and allograft packing to restore structural integrity.
The clinical workflow includes preoperative imaging and templating, informed consent discussing risks and benefits, routine preoperative labs and anesthesia evaluation, perioperative prophylactic antibiotics, operative curettage and marginal excision of the cystic lesion, preparation and implantation of allograft material into the humeral defect, intraoperative fluoroscopic confirmation of graft placement, wound closure, postoperative immobilization in a sling, pain control, and outpatient follow-up with serial radiographs to confirm graft incorporation and structural healing. Typical facility settings are an ambulatory surgery center or hospital outpatient department; anesthesia is usually general or regional block depending on patient and surgeon preference.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the work required to excise the cyst is substantially greater than typical for (extensive dissection, unusually complex reconstruction). |