Summary & Overview
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.
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. |