Summary & Overview
CPT 24565: Closed Manipulation of Humeral Epicondyle Fracture
CPT code 24565 represents a closed manipulation procedure for fractures of the humeral epicondyle, a localized injury at the elbow. This code captures non‑operative management involving manual realignment without incision, an important acute orthopedic intervention typically performed in outpatient surgical settings, ambulatory surgical centers, emergency departments, or hospital outpatient departments. Nationally, accurate use of this CPT code supports consistent billing for closed fracture management and informs utilization tracking for common elbow injuries.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service characteristics for 24565, benchmark considerations for payment and utilization, and relevant coding practice implications. The publication highlights where 24565 fits within orthopedic procedural coding and the typical settings where services are delivered. Data not available in the input is noted where applicable; the focus remains on code definition, service type, typical sites of service, and the payer landscape to aid billing staff, coding professionals, and policy analysts in understanding the role and reporting of this procedure at a national level.
Billing Code Overview
CPT code 24565 describes a closed treatment of a fracture of an epicondyle of the humerus using manipulation only, without making an incision. The procedure addresses fractures of the small bony prominence on either side of the elbow above the condyle.
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Service type: Closed fracture manipulation
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Typical site of service: Ambulatory surgical center or hospital outpatient department; may also occur in an emergency department or outpatient orthopedic clinic depending on clinical workflow and resources.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or adolescent who presents to an emergency department or orthopedic clinic after an acute elbow injury (fall onto an outstretched hand or direct blow to the elbow). The patient reports localized pain, swelling, and decreased elbow range of motion. Physical exam localizes tenderness to the medial or lateral epicondyle with possible ecchymosis. Plain radiographs (anteroposterior and lateral elbow) are obtained to confirm an epicondylar fracture and to assess displacement.
After imaging confirms a nondisplaced or minimally displaced epicondylar fracture appropriate for closed management, an orthopedic surgeon or emergency medicine physician performs a closed reduction in the procedure room or operating room under local, regional, or general anesthesia as needed. The provider manipulates the fracture fragments externally without incision, verifies alignment with intraoperative fluoroscopy or repeat radiographs, and applies a cast or splint for immobilization. Post-procedure care includes neurovascular checks, pain control, radiographic follow-up to ensure maintained reduction, and referral to orthopedic follow-up for cast management and rehabilitation planning. Typical sites of service are the emergency department, outpatient ambulatory surgical center, or hospital operating room depending on patient status and anesthesia needs.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure |