CPT 24320 Pectoralis‑to‑Biceps Transfer Reimbursement | OpenPayer

Summary & Overview

CPT 24320: Pectoralis Major to Biceps Tendon Transfer for Elbow Flexion

CPT code 24320 represents a tenoplasty procedure that repairs a tendon and transfers a muscle to restore elbow flexion lost from biceps paralysis. This reconstructive orthopedic surgery is clinically significant for patients with nerve injury, traumatic muscle loss, or palsy that impairs elbow flexion, and it can have meaningful functional and quality-of-life implications when successful. Nationally, the code is relevant to hospital and ambulatory surgical settings and is covered across major public and private payers.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and payer coverage considerations. The publication also summarizes common modifiers and billing considerations, comparative benchmark context where available, and potential documentation elements that inform medical necessity determinations. The material is intended to inform administrators, billing professionals, and clinicians about coding, service setting expectations, and common payer coverage patterns for muscle-tendon transfer procedures to restore elbow flexion.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare24320CPTupper-extremity-surgerytenoplastymuscle-transferorthopedic-reconstructionelbow-flexionsurgical-procedurebilling-codes

Billing Code Overview

CPT code 24320 describes a surgical tendon repair with transfer of a muscle (tenoplasty) performed to restore elbow flexion when the biceps muscle is paralyzed. The procedure involves transferring the pectoralis major muscle to the biceps tendon to re-establish elbow flexion function.

Service type: Surgical reconstructive procedure of the upper extremity involving tendon repair and muscle transfer
Typical site of service: Hospital operating room or ambulatory surgical center (inpatient or outpatient surgical setting depending on clinical factors)

Clinical & Coding Specifications

Clinical Context

A typical patient is a 30–60-year-old adult with loss of elbow flexion due to long-standing brachial plexus injury, traumatic rupture or paralysis of the biceps muscle, or sequelae following infection or tumor resection. The patient presents with weakness or inability to flex the elbow against gravity, affecting activities of daily living such as feeding and dressing. Preoperative evaluation includes history and physical exam documenting elbow flexion deficit, electromyography (EMG) or nerve conduction studies as indicated, imaging to assess tendon and muscle integrity, and discussion of expected functional gains and rehabilitation.

Surgical workflow: the patient undergoes general anesthesia in an operating room. The procedure 24320 (tenoplasty with transfer of a muscle) involves mobilization of the pectoralis major muscle and transfer to the biceps tendon to restore elbow flexion. Intraoperative steps include exposure of the chest and upper arm, identification and preparation of the pectoralis major tendon, creation of a secure tendon transfer to the biceps tendon, hemostasis, and layered closure. Postoperative care includes immobilization in a sling or orthosis, early wound checks, and a staged physical therapy program focusing on protected passive motion followed by progressive active strengthening to retrain the transferred muscle for elbow flexion. Follow-up visits assess wound healing, range of motion, strength recovery, and complications such as infection, hematoma, or transfer failure.

Coding Specifications

For this procedure the most clinically relevant modifiers are listed below with typical use.

Modifier	Description	When to Use

CPT 24360: Elbow Interposition (Membrane) Arthroplasty

CPT-24346-ELBOW-MEDIAL-COLLATERAL-LIGAMENT-RECONSTRUCTION-TENDON-GRAFT

CPT 24346: Elbow Medial Collateral Ligament Reconstruction with Tendon Graft

CPT-24358-TENOTOMY-DEBRIDEMENT-TENDON-CONTRACTURE

CPT 24358: Tenotomy Site Incision and Debridement for Tendon Contracture

CPT-24371-REVISION-TOTAL-ELBOW-ARTHROPLASTY-COMPONENT-EXCHANGE

CPT 24371: Revision of Total Elbow Arthroplasty, Both Components Replaced

CPT-24342-BICEPS-TRICEPS-DISTAL-TENDON-REATTACHMENT

CPT 24342: Distal Biceps or Triceps Tendon Reattachment

CPT-24363-ELBOW-PROSTHETIC-RECONSTRUCTION-UPPER-LOWER-COMPONENTS

CPT 24363: Elbow Reconstruction with Upper and Lower Prosthetic Components

CPT-24331-ELBOW-TENDON-TRANSFER-ELBOW-FLEXION-RECONSTRUCTION

CPT 24331: Elbow Tendon Transfer to Restore Elbow Flexion

CPT-24310-OPEN-TENDON-RELEASE-ELBOW-UPPER-ARM-CONTRACTURE

CPT 24310: Open Tendon Release, Elbow and Upper Arm Contracture

CPT-24498-PROPHYLACTIC-HUMERUS-FIXATION

CPT 24498: Prophylactic Fixation of Humerus to Prevent Impending Fracture

CPT-24343-ELBOW-COLLATERAL-LIGAMENT-REPAIR-DIRECT-REPAIR-NO-GRAFT

CPT 24343: Elbow Collateral Ligament Repair, Direct Repair Without Graft

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`22`	Increased procedural service	Use when work required is substantially greater than typical for `24320` (extensive dissection, revision after failed transfer).
`23`	Unusual anesthesia	Use when procedure is performed under general anesthesia but circumstances require anesthesia for normally non-anesthetized procedures (rare; include documentation).
`26`	Professional component	Use if reporting a separated professional component for a related service (eg, intraoperative monitoring interpreted separately).
`50`	Bilateral procedure	Use when bilateral pectoralis-to-biceps transfers are performed in the same operative session.
`51`	Multiple procedures	Use when `24320` is billed with other distinct procedures performed during the same operative episode.
`52`	Reduced services	Use when the procedure is intentionally partially reduced or not completed as documented.
`53`	Discontinued procedure	Use when procedure is terminated due to extenuating circumstances after initiation.
`54`	Surgical care only	Use when billing only the surgical component and another provider bills the pre/postoperative care.
`55`	Postoperative management only	Use when another surgeon performed the operative procedure and the reporting surgeon only provides post-op management.
`62`	Two surgeons	Use when two surgeons of different specialties work together as primary surgeons performing distinct portions of the transfer.
`63`	Procedure performed on infants less than 4 kg	Rare for this code; use only if applicable and documented.
`78`	Return to the operating room for a related procedure during the postoperative period	Use when a return to OR for complications related to `24320` occurs.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated procedure is performed during the global period (not listed among provided modifiers but commonly relevant; excluded if strict listing prohibits).
`LT`	Left side	Use to indicate the left arm/side involved in the procedure.
`RT`	Right side	Use to indicate the right arm/side involved in the procedure.

Taxonomy Code	Specialty	Notes
2080S0000X	Orthopedic Surgery	Orthopedic surgeons commonly perform tendon transfers for upper-extremity paralysis.
2083P0221X	Plastic and Reconstructive Surgery	Plastic surgeons perform complex soft-tissue reconstruction and muscle transfers.
2084P0800X	Neurological Surgery	Neurosurgeons may be involved for brachial plexus reconstructions in complex cases.
208H00000X	Physical Medicine & Rehabilitation	Physiatrists coordinate pre/postoperative rehabilitation and functional outcome assessments.
207P00000X	General Surgery	General surgeons may perform transfers in specific reconstructive settings when appropriate.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G54.0`	Brachial plexus disorders	Common cause of loss of elbow flexion due to nerve injury leading to muscle paralysis requiring tendon transfer.
`S46.011A`	Strain of muscle(s) and tendon(s) of the left shoulder girdle, initial encounter	Can be associated with traumatic injury leading to tendon dysfunction and eventual need for transfer if chronic.
`S46.012A`	Strain of muscle(s) and tendon(s) of the right shoulder girdle, initial encounter	As above for the right side.
`M62.81`	Muscle weakness (generalized)	Document localized muscle weakness of the biceps/arm as indication for functional restoration with transfer.
`M62.50`	Muscle wasting and atrophy, unspecified	Chronic denervation and atrophy of the biceps may prompt tendon transfer to restore function.
`T79.6XXA`	Traumatic amputation of other parts of upper limb, initial encounter	In select traumatic sequelae with loss of function, transfer procedures may be part of reconstructive strategy.
`G83.4`	Cauda equina syndrome (not typical for upper limb)	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`19360`	Mammaplasty, breast reconstruction with musculocutaneous flap (eg, TRAM, latissimus dorsi)	May be performed in patients requiring chest wall muscle mobilization or concurrent chest reconstructive procedures when pectoralis major mobilization is extensive.
`24358`	Repair, tendon, elbow area (eg, biceps)	Used for direct biceps tendon repair procedures; may be reported when native tendon repair is also performed in same encounter.
`20680`	Removal of implant; deep (eg, plates, screws)	May be used if hardware removal is required before or during the transfer to permit tendon routing.
`69990`	Microsurgical techniques, requiring use of an operating microscope (list separately in addition to code for primary procedure)	Used if microsurgical nerve repair or intricate tendon coaptation requiring microscopy is performed in conjunction.
`29827`	Arthroscopy, elbow, surgical; debridement/ synovectomy	May be performed pre- or post-transfer for joint issues that limit motion and rehabilitation.

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