Summary & Overview
CPT 24126: Excision of Radius Bone Cyst with Donor Graft
CPT code 24126 represents surgical removal of a bone cyst or benign tumor from the radius with reconstruction of the bone defect using donor graft material. This procedure is a targeted orthopedic operative service focused on lesion excision and structural repair, and it has implications for operative planning, payer coverage policies, and post-surgical care pathways nationally. Key payers in the national market include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn clinical context for when excision with grafting is coded, typical sites of service, and the elements that influence coverage and billing for such orthopedic procedures. The publication provides benchmarks and policy context relevant to hospitals and ambulatory surgical centers, highlights coding considerations for operative bone lesion management, and summarizes common modifiers and payer engagement themes. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 24126 describes surgical excision of a bone cyst or benign (noncancerous) tumor from the radius bone with subsequent filling of the resulting bone defect using grafting material from a donor. The service type is an operative orthopedic procedure involving tumor/cyst management and bone grafting. The typical site of service is an ambulatory surgical center or hospital operating room where orthopedic surgical procedures on the upper extremity are performed.
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Clinical & Coding Specifications
Clinical Context
A 28-year-old right-hand–dominant male presents with progressive dorsal wrist pain and intermittent swelling after minor trauma. Imaging (plain radiographs and MRI) identifies a benign-appearing unicameral bone cyst centered in the distal radius with cortical thinning and a small pathologic fracture risk. Nonoperative measures have failed and the orthopedic surgeon schedules an operative curettage of the lesion with placement of allograft bone graft to fill the defect.
The clinical workflow includes preoperative evaluation (history, physical exam, informed consent), preoperative imaging and planning, anesthesia evaluation, intraoperative lesion excision/curettage of the cyst or benign tumor of the radius, packing of the defect with donor (allograft) bone graft material, intraoperative fluoroscopic confirmation of defect fill and stability, wound closure, postoperative immobilization (splint or cast), pain control, and scheduled follow-up with radiographic surveillance to assess graft incorporation and healing. Typical site of service is an ambulatory surgery center or hospital outpatient surgical suite. Service type is surgical: open excision/curettage with bone grafting of the radius.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — default billing | Use as the standard submission when no other modifier applies. |