CPT 24346 Elbow MCL Reconstruction Reimbursement | OpenPayer

Summary & Overview

CPT 24346: Elbow Medial Collateral Ligament Reconstruction with Tendon Graft

CPT code 24346 represents surgical reconstruction of the medial collateral ligament of the elbow using a tendon graft to restore joint stability and function. This procedure is performed when the native ligament is insufficient for repair and a tendon graft is needed to re-create the medial (ulnar) collateral ligament complex. Nationally, it matters because it is associated with orthopedic subspecialty surgical care, episodic acute injury management, and rehabilitation pathways that influence utilization and payment in both inpatient and outpatient surgical settings.

Key payers commonly covering this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for 24346, an overview of typical sites of service (hospital OR or ambulatory surgery center), and the types of benchmarks and policy elements typically relevant to this code, such as utilization patterns, coding guidance, and payer coverage considerations. Data not available in the input will be noted where applicable. This publication aims to provide clinicians, coding professionals, and policy analysts with the foundational information needed to understand the code’s clinical intent, typical care setting, and the payers most likely to be involved in coverage and reimbursement decisions.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare24346CPTelbow surgeryligament reconstructiontendon graftorthopedicssurgical procedureambulatory surgeryhospital operating room

Billing Code Overview

CPT code 24346 describes reconstruction of the medial collateral ligament of the elbow using a tendon graft to restore elbow stability and function. This surgical procedure addresses significant ligamentous injury to the medial (ulnar) collateral ligament complex, typically when primary repair is not sufficient and a graft is required to reestablish joint stability.

Service type: Surgical ligament reconstruction using a tendon graft
Typical site of service: Hospital operating room or ambulatory surgery center

Clinical & Coding Specifications

Clinical Context

A Thirty-five-year-old recreational athlete presents after a fall onto an outstretched hand with acute medial elbow pain, swelling, and instability. Clinical exam demonstrates valgus instability at 30° flexion and tenderness over the medial elbow. Imaging (radiographs and MRI) confirms a complete tear of the medial collateral ligament (ulnar collateral ligament) of the elbow with associated valgus laxity. Nonoperative management (rest, immobilization, physical therapy) was attempted for 6 months with persistent symptomatic instability and inability to return to athletic activity. The patient is scheduled for surgical reconstruction of the medial collateral ligament using an autologous tendon graft under general anesthesia.

Preoperative workflow includes history and physical, informed consent documenting risks/benefits, review of imaging, anesthesia assessment, and perioperative antibiotic prophylaxis. Intraoperative steps typically include patient positioning, exposure of the medial elbow, preparation of a tendon graft (commonly palmaris longus or gracilis), creation of bone tunnels or fixation points in the humerus and ulna, graft passage and tensioning to restore valgus stability, and layered wound closure. Postoperative workflow includes immediate immobilization in a splint, analgesia, wound care instructions, staged rehabilitation with gradual range-of-motion and strengthening, and follow-up visits with serial stability testing and documentation of progress.

Coding Specifications

Modifier	Description	When to Use
`25`

CPT 24366: Elbow Prosthetic Cap on Proximal Radius

CPT-24345-ELBOW-MEDIAL-COLLATERAL-LIGAMENT-REPAIR-LOCAL-TISSUE

CPT 24345: Elbow Medial Collateral Ligament Repair, Local Tissue

CPT-24400-HUMERAL-OSTEOTOMY-EXCISIONAL-REALIGNMENT

CPT 24400: Humeral Osteotomy for Realignment and External Rotation

CPT-24320-PECTORALIS-MAJOR-TO-BICEPS-TENDON-TRANSFER-ELBOW-FLEXION-RESTORATION

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

CPT-24365-RADIUS-EXCISION-ELBOW-RECONSTRUCTION

CPT 24365: Excision of Distal Radius for Elbow Joint Reconstruction

CPT-24305-UPPER-ARM-ELBOW-TENDON-LENGTHENING-CONTRACTURE-RELEASE

CPT 24305: Upper Arm/Elbow Tendon Lengthening for Contracture Release

CPT-24332-TRICEPS-TENDON-RELEASE-ELBOW-FLEXION

CPT 24332: Triceps Tendon Release for Elbow Flexion

CPT-24358-TENOTOMY-DEBRIDEMENT-TENDON-CONTRACTURE

CPT 24358: Tenotomy Site Incision and Debridement for Tendon Contracture

CPT-24357-PERCUTANEOUS-NEEDLE-TENOTOMY-TENDON-FENESTRATION

CPT 24357: Percutaneous Needle Tenotomy for Tendon Scar Contracture

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

CPT 24363: Elbow Reconstruction with Upper and Lower Prosthetic Components

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Taxonomy Code	Specialty	Notes
207L00000X	Orthopaedic Surgery	Primary specialty performing elbow medial collateral ligament reconstruction.
208000000X	General Surgery	In some settings general or trauma surgeons perform complex elbow reconstructions.
163WL0800X	Sports Medicine (Orthopedics)	Subspecialty focusing on athletes and ligament reconstructions.
207X00000X	Hand Surgery	Surgeons with hand/elbow focus who manage complex elbow ligament injuries.
2084P0800X	Orthopedic Spine (not typical)	Data not primary for this procedure but occasionally coded in practices with broader orthopedic taxonomy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S53.41XA`	Sprain of ulnar collateral ligament of right elbow, initial encounter	Common acute diagnosis for medial collateral ligament sprain/tear on the right side leading to reconstruction.
`S53.42XA`	Sprain of ulnar collateral ligament of left elbow, initial encounter	Common acute diagnosis for medial collateral ligament sprain/tear on the left side leading to reconstruction.
`M24.221`	Recurrent dislocation, right elbow	Chronic instability that may indicate need for ligament reconstruction.
`M24.222`	Recurrent dislocation, left elbow	Chronic instability on the left elbow requiring reconstructive surgery.
`S53.431A`	Complete tear of ulnar collateral ligament of right elbow, initial encounter	Specific traumatic complete tear often managed with graft reconstruction.
`S53.432A`	Complete tear of ulnar collateral ligament of left elbow, initial encounter	Specific traumatic complete tear on the left side commonly treated with reconstruction.
`M25.831`	Other instability, right elbow	Descriptive code for symptomatic instability supporting surgical intervention.
`M25.832`	Other instability, left elbow	Descriptive code for instability of the left elbow relevant to reconstruction.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`24346`	Repair, medial collateral ligament, elbow; reconstruction with graft (Note: primary code)	This is the primary operative code describing medial collateral ligament reconstruction using a tendon graft.
`20680`	Removal of implant; deep (e.g., buried); requiring removal of deep implant	May be performed prior to reconstruction if prior hardware removal is required.
`25350`	Reconstruction, collateral ligament, elbow; repair or reattachment (not using graft)	Alternative or adjunct procedure when primary repair is possible without grafting.
`29880`	Arthroscopy, elbow, surgical; with lysis of adhesions, with or without synovectomy	May be performed arthroscopically prior to or during reconstruction to address intra-articular pathology.
`99223`	Initial hospital care, per day, high severity	Example of an inpatient E/M code used for preoperative or postoperative inpatient admissions related to the surgery.
`20670`	Removal of foreign body, deep (e.g., intra-articular)	Performed if a retained fragment or foreign body is discovered and removed during reconstruction.

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