CPT 24342: Distal Biceps or Triceps Tendon Reattachment
CPT code 24342 represents surgical reattachment of a torn or separated distal biceps or triceps tendon to bone. This procedure is a definitive orthopedic intervention to restore elbow flexion or extension strength and function after tendon avulsion. Nationally, it matters because timely surgical repair can reduce long-term disability and downstream costs associated with loss of upper-extremity function.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when 24342 is used, the typical settings where the procedure is performed, and which payers commonly cover or adjudicate claims for this service. The publication outlines billing benchmarks, expected site-of-service patterns, documentation considerations tied to surgical tendon reattachment, and any notable policy or coverage updates where available. Data not available in the input will be noted as such in relevant sections.
This overview is intended for clinicians, coding professionals, and policy analysts seeking a focused briefing on the clinical purpose, payer landscape, and practical billing context for CPT code 24342.
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Billing Code Overview
CPT code 24342 describes surgical reattachment of a torn or separated distal end of a biceps or triceps tendon back to the bone from which it detached. This procedure restores tendon-to-bone continuity and is performed when the distal tendon has avulsed or otherwise separated, compromising muscle function.
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Service type: Surgical tendon repair/reattachment
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 42-year-old recreational weightlifter presents with acute elbow pain after a forceful eccentric contraction while lifting, with visible deformity and weakness in elbow flexion. Examination and imaging confirm a complete distal biceps tendon avulsion from the radial tuberosity. The patient is scheduled for surgical reattachment of the distal biceps tendon to the radial tuberosity under general anesthesia. Preoperative workflow includes history, focused musculoskeletal exam, MRI or ultrasound confirmation, informed consent, anesthesia assessment, and preoperative antibiotics. Intraoperative workflow includes regional block or general anesthesia, incision at the antecubital fossa, identification and mobilization of the retracted tendon, preparation of the radial tuberosity, fixation of the tendon to bone with suture anchors or cortical button technique, hemostasis, layered closure, sterile dressing, and postoperative immobilization in a sling or hinged elbow brace. Postoperative care includes pain management, wound checks, early protected range-of-motion per surgeon protocol, and referral to physical therapy for progressive strengthening and return-to-activity planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the work, time, or technical difficulty substantially exceeds typical for 24342. |
52 | Reduced services | Use when the service is partially reduced or not completed as planned (e.g., limited repair). |
53 | Discontinued procedure | Use when the procedure is started but discontinued due to extenuating circumstances. |
62 | Two surgeons | Use when two surgeons with different specialties collaborate and both perform distinct portions of 24342. |
66 | Surgical team | Use when a surgical team approach is used and billing requires the team modifier. |
76 | Repeat procedure by same physician | Use when the same physician repeats 24342 within the postoperative period due to complication or failure. |
77 | Repeat procedure by another physician | Use when another physician performs a repeat of 24342 (note: 77 is not in the provided list; therefore do not use it). |
78 | Unplanned return to OR for related procedure during global period | Use when a return to the operating room is required for a complication related to the initial 24342. |
79 | Unrelated procedure or service by same physician during global period | Use when an unrelated surgical procedure is performed during the global period of 24342. |
50 | Bilateral procedure | Use when the procedure is performed on both upper extremities during the same operative session (rare for distal biceps). |
RT | Right side | Use to indicate the procedure was performed on the right limb. |
LT | Left side | Use to indicate the procedure was performed on the left limb. |
AS | Ambulatory surgical center | Use to indicate the service was performed at an ASC when applicable. |
26 | Professional component | Use when only the professional component is being reported (rare for operative procedure coding). |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207L00000X | Orthopaedic Surgery | Orthopaedic surgeons commonly perform distal biceps and triceps tendon repair. |
| 2084P0400X | Hand Surgery | Hand surgeons perform complex distal tendon repairs around the elbow and forearm. |
| 207X00000X | General Surgery | Some general surgeons with upper-extremity training may perform tendon reattachment in selected settings. |
| 207R00000X | Physical Medicine & Rehabilitation | PM&R physicians manage postoperative rehabilitation and functional recovery planning. |
| 207K00000X | Sports Medicine | Sports medicine specialists within orthopaedics commonly evaluate and coordinate surgical care for athletic tendon injuries. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
S46.011A | Strain of muscle, fascia and tendon of muscle(s) and tendon(s) at shoulder and upper arm level, right arm, initial encounter | Distal biceps avulsion presenting as acute upper arm tendon injury; may be used when documentation specifies acute strain/avulsion. |
S46.012A | Strain of muscle, fascia and tendon of muscle(s) and tendon(s) at shoulder and upper arm level, left arm, initial encounter | Same relevance for left-sided acute distal biceps injuries. |
S46.019A | Strain of muscle, fascia and tendon of unspecified site of shoulder and upper arm, initial encounter | Used when laterality or exact site is not specified but relates to upper arm tendon injury. |
S46.111A | Laceration of tendon of biceps muscle at forearm level, right arm, initial encounter | Indicates tendon laceration or complete rupture at distal insertion requiring reattachment. |
S46.112A | Laceration of tendon of biceps muscle at forearm level, left arm, initial encounter | Same as above for left-sided injuries. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
29827 | Arthroscopy, elbow, surgical; debridement, limited | May be performed arthroscopically for concomitant intra-articular pathology identified preoperatively or intraoperatively. |
24341 | Repair of ruptured triceps or biceps tendon, long head or proximal? (Note: 24341 is not provided in input) | Data not available in the input. |
20680 | Removal of implant; deep (e.g., buried wires, pins, plates, screws) when performed at same site | Performed if prior fixation hardware needs removal before tendon reattachment. |
27096 | Application of external fixation system (unlisted here for elbow) | May be used rarely when additional stabilization is required post-repair. |
20550 | Injection(s); single tendon sheath, ligament, or trigger point | May be used postoperatively for diagnostic or therapeutic injections during recovery. |