Summary & Overview
CPT 24640: Closed Reduction of Partially Dislocated Pediatric Elbow
CPT code 24640 describes a closed (non‑open) reduction of a partially dislocated elbow in a pediatric patient. It captures the clinical act of manipulating the joint externally to restore anatomic position without surgical exposure. This procedure is commonly performed in acute care settings and is relevant nationally due to the frequency of pediatric elbow injuries and implications for emergency, orthopedic, and outpatient procedural billing.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise national perspective on what the code represents, typical sites of service, and how the code is used in clinical and billing workflows. The publication outlines benchmarks and payment context where available, summarizes relevant policy considerations that affect reimbursement and coverage, and provides clinical context to help payers and providers align documentation with billing expectations.
The report is intended for health plan analysts, practice managers, and clinicians seeking a clear summary of the code’s clinical meaning, common use cases, and the types of analyses and policy updates that influence payment and utilization. Data not available in the input will be identified as such.
Billing Code Overview
CPT code 24640 describes a non‑open reduction procedure for a partially dislocated elbow in a child. The provider manipulates the joint externally to restore correct anatomical alignment without surgically opening the site of dislocation.
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Service type: Closed (non‑open) reduction of a partially dislocated pediatric elbow
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Typical site of service: Emergency department, urgent care, or outpatient surgical/procedural unit where procedural sedation or analgesia can be provided
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Clinical & Coding Specifications
Clinical Context
A 7-year-old child presents to the emergency department after a fall from playground equipment with acute pain, visible deformity about the elbow, swelling, and limited active motion. Initial evaluation by an emergency physician includes focused neurovascular exam of the affected limb and plain radiographs (AP and lateral) to assess for fracture or joint incongruity. Imaging demonstrates a partial elbow dislocation (subluxation) without an associated open wound or need for internal fixation. After analgesia and conscious sedation per protocol, the treating physician performs a closed reduction maneuver to manipulate the joint back into its correct anatomic alignment. Post-reduction neurovascular status is documented, repeat radiographs confirm reduction, and the elbow is immobilized in a splint or cast. Disposition includes short observation for complications and orthopedic follow-up within 7–10 days.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure | Use when a distinct E/M visit is provided same day as the closed reduction and is documented separately. |
52 | Reduced services |