Summary & Overview
CPT 24130: Radial Head Excision for Elbow Fracture
CPT code 24130 represents surgical excision of the radial head through intra-articular access to treat radial head fractures or severe elbow injuries. The procedure is clinically significant because radial head fractures are among the most common adult elbow fractures and can produce substantial functional loss; excision is a treatment option when fixation is not feasible or when associated injuries and severity influence decision-making. Nationally, this code captures an operative orthopedic service rendered in hospitals and ambulatory surgical centers and is relevant to surgical care pathways, postoperative management, and payer coverage policies.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the code, expected sites of service, and typical service classification. The publication also provides benchmarks and payment context where available, notes on common billing modifiers, and highlights policy considerations affecting authorization and coverage. Clinical readers will gain clarity on when excision is used versus fixation; operational readers will see implications for coding, billing, and revenue cycle workflows. Data not available in the input is explicitly identified where applicable.
Billing Code Overview
CPT code 24130 describes a surgical procedure in which the provider enters the elbow joint and excises the radial head, typically performed after an elbow injury or a fracture of the radial head. This procedure addresses displaced or comminuted radial head fractures that impair elbow function and can contribute to major disability if untreated.
-
Service type: Surgical excision of radial head; orthopedic operative procedure
-
Typical site of service: Hospital operating room or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45–65-year-old adult who presents after a fall onto an outstretched hand or direct elbow trauma with pain, swelling, and limited forearm rotation. Imaging (plain radiographs ± CT) demonstrates a displaced radial head fracture with comminution or mechanical block to motion. After initial assessment, splinting and neurovascular exam are documented. The orthopedic surgeon discusses operative options and obtains informed consent for surgical excision of the radial head (CPT 24130) when fixation is not feasible or when the radial head is highly comminuted and associated with other elbow instability requiring resection.
Preoperative workflow includes history and physical, updated imaging review, anesthesia evaluation, and documentation of laterality using modifier LT or RT. Intraoperative steps include sterile preparation of the elbow, a tourniquet as indicated, incision and exposure of the radiocapitellar joint, excision of the radial head fragments, irrigation, hemostasis, and closure; intraoperative fluoroscopy may be used to confirm removal. Postoperative workflow includes recovery, pain control, immobilization protocol or early range-of-motion per surgeon preference, physical therapy referral, and follow-up radiographs to confirm joint alignment and absence of retained fragments.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|