Summary & Overview
CPT 24362: Distal Humerus Prosthesis Cap with Fascia Lata Reconstruction
CPT code 24362 identifies a surgical orthopedic procedure that fits an artificial prosthetic cap on the distal humerus and reconstructs the joint capsule with a fascia lata graft from the thigh. This operation is used in complex elbow or distal humeral reconstructions where prosthetic coverage and soft-tissue stabilization are required. Nationally, the code matters because it captures specialized reconstructive work with implications for surgical resource use, device billing, and post-operative rehabilitation.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a focused overview of clinical context, typical sites of service, and common administrative considerations tied to this code. The publication summarizes available benchmarks where present, highlights policy and coverage considerations that affect access and payment, and outlines coding and billing elements relevant to hospital and ambulatory settings.
The report is intended for clinical administrators, coding professionals, and policy analysts who need a concise reference on the clinical definition, setting, and payer landscape for CPT code 24362. Data not available in the input is noted where applicable and not inferred.
Billing Code Overview
CPT code 24362 describes a surgical procedure in which a provider fits an artificial prosthesis cap on the distal end of the humerus and reconstructs the joint capsule using a fascia lata graft harvested from the thigh. This procedure is an orthopedic reconstructive operation involving prosthetic implantation and soft-tissue grafting.
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Service type: Surgical implant procedure with autologous graft reconstruction
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A typical patient is a 60-year-old woman with severe post-traumatic or degenerative destruction of the distal humeral articular surface and rotator cuff insufficiency who presents with persistent shoulder pain, limited range of motion, and functional loss despite conservative care. Preoperative evaluation includes history and physical, shoulder radiographs and CT or MRI to assess bone stock and soft tissues, and anesthesia clearance. The surgical workflow for 24362 involves harvesting a fascia lata graft from the lateral thigh, preparing the distal humerus, fitting an artificial prosthetic cap onto the distal humeral end, and reconstructing the joint capsule with the fascia lata graft to restore stability. Intraoperative steps include antibiotic prophylaxis, patient positioning in beach chair or lateral decubitus as appropriate, incision and exposure of the distal humerus and joint, prosthesis trialing and implantation, graft harvest and capsule reconstruction, hemostasis, layered closure, and application of postoperative immobilization. Postoperative care includes pain control, wound checks, physical therapy focusing on protected passive motion advancing to active rehabilitation, and follow-up imaging to confirm implant position and graft incorporation. Typical sites of service are an ambulatory surgery center or hospital outpatient department; inpatient admission may occur for medically complex patients or if complications arise.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
RT |