Summary & Overview
CPT 24560: Closed Treatment of Epicondyle Fracture of Humerus
CPT code 24560 designates closed, non‑operative treatment of an epicondyle fracture of the humerus — an elbow injury managed without incision or fracture manipulation. This procedural code is relevant to orthopedic, emergency, and outpatient surgical care nationwide because it captures a specific noninvasive management pathway for a common elbow fracture pattern.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when CPT code 24560 is used, the typical sites of service where it is billed, and the categories of payers that commonly reimburse for this service. The publication also outlines what to expect in benchmarking and policy coverage areas: comparative fee benchmarks across major payers, common billing considerations for nonoperative fracture care, and any recent policy clarifications that affect coverage and coding for closed epicondyle fracture treatment.
This summary serves clinicians, billing professionals, and policy analysts seeking a clear, national‑level reference on CPT code 24560, its clinical application, and the payer landscape relevant to nonoperative elbow fracture management. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 24560 describes a closed treatment of a fracture of an epicondyle of the humerus. The epicondyle is a small bony prominence on either side of the elbow near the top of the upper arm bone; this code applies when the provider manages the fracture without making an incision and without manipulating the fracture.
Service Type: Closed fracture treatment, non‑operative
Typical Site of Service: Hospital outpatient department, ambulatory surgical center, or clinic setting
Clinical & Coding Specifications
Clinical Context
A typical patient is a 10–35 year-old presenting to the emergency department or orthopedic clinic after a fall onto an outstretched hand or direct blow to the elbow. The patient reports localized pain, swelling, and limited elbow motion. Physical exam shows point tenderness over the medial or lateral epicondyle with ecchymosis. Plain radiographs demonstrate a non-displaced or minimally displaced epicondyle fracture of the humerus. The provider performs a closed treatment without incision or formal manipulation: immobilization with a posterior splint or long-arm cast is applied in the ED or procedure area. Instructions for pain control, neurovascular checks, and follow-up with orthopedics are provided. If the fracture remains stable on follow-up radiographs, continued conservative care is documented. If displacement progresses, conversion to operative fixation is considered at follow-up but is not part of this closed procedure.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier | Use when no other modifier applies and no special circumstances are documented |
52 | Reduced services | Use when the closed procedure is partially reduced in scope compared to the full service |