CPT 24400 Humeral Osteotomy Reimbursement | OpenPayer

Summary & Overview

CPT 24400: Humeral Osteotomy for Realignment and External Rotation

CPT code 24400 covers surgical excision of a humeral segment to realign the upper arm and restore external rotation in the setting of a congenital deformity, often with internal fixation. Nationally, this procedure is important for functional restoration in pediatric and adult patients with congenital or developmental humeral malalignment, and it affects surgical utilization, payer coverage determinations, and bundled-payment considerations. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and which payers are included in the coverage review. The publication summarizes common modifiers and coding considerations when available, highlights typical service lines and settings, and identifies where input data are not available. It frames benchmarking and policy-relevant points for administrators, clinicians, and billing professionals evaluating authorization, claims submission, and reimbursement workflows for an upper-extremity orthopedic osteotomy procedure.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 24400orthopedic surgeryhumerus osteotomyupper extremitysurgical procedureambulatory surgical centerinpatient surgeryprocedure codingorthopedics

Billing Code Overview

CPT code 24400 describes an operative procedure in which the provider excises a segment of the humerus to realign the bone and enable external rotation of the arm for a congenital deformity. The description indicates the provider may apply internal fixation hardware to strengthen the repair.

Service type: Surgical orthopedic procedure (osteotomy/excisional realignment of the humerus)
Typical site of service: Inpatient or outpatient surgical setting such as an operating room in a hospital or ambulatory surgical center

Clinical & Coding Specifications

Clinical Context

A typical patient is a pediatric or adolescent presenting with a congenital upper-arm rotational deformity (such as internal rotation contracture from Erb palsy or congenital humeral malrotation) that significantly limits external rotation, functional reach, and activities of daily living. The orthopedic surgeon evaluates with history, physical exam, and imaging (plain radiographs and occasionally CT) demonstrating malrotation or segmental deformity of the humerus. After conservative measures (physical therapy, orthoses, Botox if applicable) fail to restore functional external rotation, the patient is scheduled for a humeral osteotomy.

During the operative workflow, under general anesthesia in an operating room, the surgeon exposes the humerus, excises a segment of bone or performs a corrective osteotomy to realign the humerus and restore external rotation. Internal fixation (plates, screws, or intramedullary devices) may be applied to stabilize the osteotomy. Intraoperative neurovascular protection and fluoroscopy are commonly used. Postoperative care includes pain control, immobilization (sling or splint), early controlled range-of-motion therapy, and outpatient follow-up with radiographic assessment to confirm union and alignment. Typical sites of service are inpatient or outpatient hospital operating rooms or ambulatory surgery centers depending on patient age, comorbidity, and extent of procedure.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services

CPT 24345: Elbow Medial Collateral Ligament Repair, Local Tissue

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

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

CPT-24498-PROPHYLACTIC-HUMERUS-FIXATION

CPT 24498: Prophylactic Fixation of Humerus to Prevent Impending Fracture

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

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

CPT-24470-ELBOW-EPIPHYSIODESIS-GROWTH-PLATE-ARREST

CPT 24470: Elbow Growth Plate Arrest (Stapling/Plating)

CPT-24330-ELBOW-FLEXOR-TRANSFER-RECONSTRUCTION

CPT 24330: Elbow Flexor Muscle Transfer to Increase Flexion Strength

CPT-24366-ELBOW-RADIUS-PROSTHETIC-CAP-IMPLANTATION

CPT 24366: Elbow Prosthetic Cap on Proximal Radius

CPT-24301-TENDON-MUSCLE-TRANSFER-UPPER-ARM-ELBOW

CPT 24301: Tendon/Muscle Transfer, Upper Arm or Elbow

CPT-24340-DISTAL-BICEPS-TENDON-REPAIR

CPT 24340: Distal Biceps Tendon Repair

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

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

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Taxonomy Code	Specialty	Notes
207L00000X	Orthopaedic Surgery	Primary specialty performing humeral osteotomy and fixation.
2080P0222X	Pediatric Orthopedic Surgery	Pediatric specialty for congenital deformity corrections in children.
208100000X	Orthopedic Hand Surgery	May be involved when concurrent distal upper-extremity issues or complex rotational deformities impact hand function.
2083P0205X	Sports Medicine (Orthopaedic)	May perform corrective osteotomies in adolescent patients with functional impairment.
207K00000X	General Surgery	Data not typically applicable; included only if local practice patterns employ general surgeons — otherwise not commonly performing `24400`.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q74.2`	Congenital deformity of humerus	Directly relevant — congenital malalignment requiring osteotomy for rotation correction.
`M21.30`	Other acquired deformity of limb, unspecified limb	May capture acquired malrotation or deformity of the humerus when congenital code not used.
`M24.219`	Stiffness of joint, unspecified shoulder	Shoulder stiffness accompanying humeral malrotation that limits external rotation.
`G54.0`	Brachial plexus lesions, unspecified	Relevant when obstetric brachial plexus injury leads to internal rotation contracture and humeral osteotomy is indicated.
`M89.8`	Other specified disorders of bone	Used for atypical bone disorders or malunions requiring segment excision and realignment.
`S42.201A`	Unspecified fracture of shaft of humerus, initial encounter for closed fracture	Included when malunion from prior fracture necessitates corrective osteotomy.
`Q65.8`	Other congenital deformities of lower limb — Data not appropriate: Data not available in the input.
`M25.611`	Stiffness of right shoulder	Specific laterality when shoulder stiffness relates to the operative side.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11042`	Debridement, subcutaneous tissue; first 20 sq cm or less	May be used for soft-tissue debridement in the same operative field if necrotic or contracted tissue is addressed during osteotomy.
`20680`	Removal of implanted internal fixation device; deep (e.g., buried wire, pin, screw, metal band, nail, rod or plate)	Performed later if hardware placed at the time of `24400` requires removal.
`20690`	Arthrocentesis, aspiration and/or injection; major joint or bursa	Used postoperatively if joint aspiration or steroid injection is clinically indicated (rarely related).
`77002`	Fluoroscopic guidance for needle placement (note: imaging guidance CPTs vary)	Intraoperative fluoroscopy is commonly used to confirm osteotomy alignment and hardware placement — specific imaging codes billed per facility.
`99024`	Postoperative follow-up visit global period (note: represent E/M within global)	Represents postoperative care visits during the global surgical period; local payer rules determine billing.

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