Summary & Overview

CPT 24516: Humeral Shaft Internal Fixation with Intramedullary Rod

CPT code 24516 represents surgical internal fixation of a humeral shaft fracture, commonly performed with an intramedullary rod and optional cerclage or locking screws. This code matters nationally because humeral shaft fractures are a frequent orthopedic injury requiring operative management to restore limb function and reduce long-term disability. Accurate coding for this procedure affects hospital and surgeon billing, resource allocation, and quality measurement for orthopedic trauma care.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, typical sites of service, and which payers commonly reimburse for operative fracture care. The publication also summarizes benchmarks and policy-relevant considerations such as reimbursement patterns, prior authorization trends, and documentation elements that influence claims adjudication. Clinical readers will gain clarity on the procedure's intent and typical setting, while billing and policy audiences will find guidance on where to look for reimbursement policies and common coverage considerations nationally.

Data not available in the input is explicitly noted where payer-specific rates, related codes, ICD-10 pairings, and associated taxonomies are absent.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare24516CPThumeral shaft fractureinternal fixationorthopedic surgeryintramedullary rodambulatory surgical centerhospital

Billing Code Overview

CPT code 24516 describes surgical treatment of a humeral shaft fracture using internal fixation implants such as an intramedullary rod, with optional use of cerclage and/or locking screws. This procedure is an operative fracture treatment of the humeral diaphysis and involves stabilization of the humeral shaft to restore alignment and enable healing.

Service type: Surgical open or closed internal fixation of the humeral shaft
Typical site of service: Hospital operating room or ambulatory surgical center

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 46-year-old male motorcyclist presents to the emergency department after a high-energy collision with deformity, swelling, and focal pain to the midshaft of the right humerus. Imaging demonstrates a displaced transverse midshaft humeral fracture with cortical disruption and mild shortening. The orthopedic trauma team evaluates the patient, obtains preoperative clearance, and schedules operative management with intramedullary fixation. In the operating room under general anesthesia, the surgeon performs open or percutaneous reduction and inserts an intramedullary rod (nail) into the humeral shaft, using locking screws and adjunctive cerclage wires as needed to obtain stability. Intraoperative fluoroscopy confirms alignment and implant position. Postoperatively, the patient is transferred to the post-anesthesia care unit for monitoring, provided regional or systemic analgesia, and given instructions for activity restrictions and outpatient follow-up for wound checks and radiographic assessment of healing. Typical documentation includes operative report describing approach, implants used (rod, locking screws, cerclage), laterality, estimated blood loss, complications (if any), and postoperative plan.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use if reporting only the surgeon's professional service separate from technical facility billing (rare for OR procedures).
`51`	Multiple procedures	Use when multiple distinct CPT surgical procedures are performed during the same operative session.
`52`	Reduced services	Use if the procedure is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when the procedure is started but terminated for patient-related or unforeseen reasons.
`62`	Two surgeons	Use when two surgeons with distinct expertise perform parts of the procedure together.
`63`	Procedure performed on infants/neonates	Use when performed on a neonate/infant requiring age-specific modifier.
`78`	Unplanned return to OR by same physician following initial procedure	Use for immediate or early reoperation for complications related to the initial fixation.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated procedure is performed during the global period.
`80`	Assistant surgeon	Use when an assistant (not resident) actively assists in the procedure.
`81`	Minimum assistant surgeon	Use when a minimal assistant role is documented.
`82`	Assistant surgeon (when a qualified resident surgeon is not available)	Use when a qualified resident is not available and an assistant is used.
`58`	Staged or related procedure by same physician during the postoperative period	Use for planned staged fixation or conversion procedures.
`22`	Increased procedural services	Use if the procedure required substantially greater effort, time, or complexity than typical.
`59`	Distinct procedural service	Use to indicate a procedural service separate and independent from other services on the same day.

Taxonomy Code	Specialty	Notes
207L00000X	Orthopaedic Surgery	Primary specialty performing humeral shaft fixation.
2080P0202X	General Surgery	May perform trauma fixation in some settings or when orthopedics unavailable.
207X00000X	Sports Medicine (Orthopedic)	May manage operative fixation in athletes or referral centers.
208000000X	Emergency Medicine	Initial evaluation and stabilization; not the operative provider.
363L00000X	Physical Medicine & Rehabilitation	Manages postoperative rehab and functional recovery.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S42.301A`	Unspecified fracture of shaft of right humerus, initial encounter for closed fracture	Common presenting diagnosis for midshaft humeral fractures treated with IM fixation.
`S42.302A`	Unspecified fracture of shaft of left humerus, initial encounter for closed fracture	As above for left-side injuries.
`S42.331A`	Spiral fracture of shaft of right humerus, initial encounter for closed fracture	Spiral fractures may be amenable to intramedullary fixation for rotational stability.
`S42.332A`	Spiral fracture of shaft of left humerus, initial encounter for closed fracture	Left-sided spiral fracture variant.
`S42.351A`	Transverse fracture of shaft of right humerus, initial encounter for closed fracture	Transverse patterns often stabilized with IM nails and locking screws.
`S42.352A`	Transverse fracture of shaft of left humerus, initial encounter for closed fracture	Left-sided transverse fracture.
`M84.30XA`	Stress fracture, unspecified site, initial encounter	Considered when fracture results from pathologic or stress mechanism; may alter fixation planning.
`M84.9`	Disorder of bone density and structure, unspecified	Relevant when bone quality (e.g., osteoporosis) affects implant choice and fixation strategy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`24505`	Open treatment of humeral shaft fracture, with plate/screws, with or without cerclage or intramedullary fixation	Alternative open fixation technique; used when plating rather than IM nailing is chosen.
`20680`	Removal of implant; deep (e.g., intramedullary rod)	Performed if later removal of the intramedullary rod is indicated for pain, infection, or nonunion.
`20670`	Application/removal of external fixation	Used when temporary external fixation is applied before definitive IM nailing.
`76000`	Fluoroscopy (separate procedure)	Intraoperative fluoroscopic guidance is commonly used to position guidewires and implants; may be billed by facility or service depending on setting.
`27096`	I & D or debridement of bone (adjacent code example)	Used if debridement for infection or nonunion is necessary in the perioperative period.