CPT 24665 Radial Head Repair Reimbursement | OpenPayer

Summary & Overview

CPT 24665: Open Repair of Radial Head or Neck Fracture

CPT code 24665 denotes open surgical treatment of fractures at the head or neck of the radius via an elbow incision, often involving excision of bone fragments and internal fixation with screws or wires. This procedure is clinically significant due to its implications for elbow stability, forearm rotation, and long-term functional outcomes after trauma. Nationally, accurate coding of proximal radial fracture repair guides appropriate surgical reimbursement and supports quality measurement for upper extremity trauma care.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for CPT code 24665, common payment and coding considerations tied to operative management of radial head/neck fractures, and the kinds of benchmarks and policy topics that affect coverage and utilization for inpatient and ambulatory surgical settings. The publication also outlines operative service lines, typical sites of service, and where to look for related coding guidance.

The content is intended to help billing managers, orthopaedic surgeons, and policy analysts understand the code’s clinical scope and payer landscape, and to identify areas where coding precision and documentation affect authorization and reimbursement. Data not available in the input are noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 24665orthopedic surgeryupper extremityradial head fractureopen reduction internal fixationambulatory surgeryoperative codingtrauma surgery

Billing Code Overview

CPT code 24665 describes a surgical procedure to treat a fracture of the radial head or radial neck through an incision made at the elbow. The provider may excise a portion of bone and/or apply internal fixation devices such as screws or wires to stabilize the fracture.

Service type: Surgical fracture repair of the proximal radius (open treatment)
Typical site of service: Operating room or ambulatory surgery center with postoperative recovery

Clinical & Coding Specifications

Clinical Context

A 45-year-old right-hand–dominant construction worker presents to the emergency department after a fall onto his outstretched hand with acute right elbow pain, swelling, and limited forearm rotation. Imaging demonstrates a displaced radial head fracture involving the radial head/neck with mechanical block to forearm pronation and supination. After closed reduction attempts are unsuccessful or the fracture is unstable, the orthopedic surgeon schedules operative management under general anesthesia. In the operating room an incision at the lateral elbow exposes the radial head/neck; the surgeon performs open treatment which may include partial excision of comminuted fragments, open reduction and internal fixation with screws or wires, or radial head replacement if indicated. Intraoperative fluoroscopy confirms reduction and implant position. Postoperative workflow includes immediate neurovascular checks, immobilization in a splint or cast, pain control, and early referral to outpatient physical therapy for progressive range-of-motion and strengthening. Typical documentation includes operative report with laterality, approach (elbow incision), fixation method (screws/wires/excision), estimated blood loss, implants used, and postoperative condition.

Coding Specifications

Modifier	Description	When to Use
`50`	Bilateral procedure	Use if both left and right radial heads are treated during the same operative session.

CPT 24655: Closed Reduction and Splinting of Radial Head/Neck Fracture

CPT-24516-HUMERAL-SHAFT-INTERNAL-FIXATION-INTRAMEDULLARY-ROD

CPT 24516: Humeral Shaft Internal Fixation with Intramedullary Rod

CPT-24586-OPEN-ELBOW-FRACTURE-REPAIR

CPT 24586: Open Repair of Elbow Fracture or Dislocation

CPT-24538-HUMERUS-SUPRACONDYLAR-PERCUTANEOUS-FIXATION

CPT 24538: Percutaneous Fixation of Humeral Supracondylar Fracture

CPT-24565-CLOSED-MANIPULATION-EPICONDYLE-FRACTURE-HUMERUS

CPT 24565: Closed Manipulation of Humeral Epicondyle Fracture

CPT-24575-OPEN-EPICONDYLAR-FRACTURE-REPAIR-HUMERUS

CPT 24575: Open Repair of Epicondylar Humerus Fracture

CPT-24535-HUMERUS-CONDYLAR-FRACTURE-CLOSED-REDUCTION

CPT 24535: Closed Treatment of Humerus Condylar Fracture (Without Open Incision)

CPT-24530-CLOSED-TREATMENT-HUMERUS-CONDYLAR-FRACTURE

CPT 24530: Closed Treatment of Humerus Fracture Through or Above Condyle

CPT-24640-CLOSED-REDUCTION-PARTIAL-PEDIATRIC-ELBOW-DISLOCATION

CPT 24640: Closed Reduction of Partially Dislocated Pediatric Elbow

CPT-24675-PROXIMAL-ULNA-FRACTURE-CLOSED-TREATMENT-SPLINTING

CPT 24675: Closed Treatment of Proximal Ulna Fracture

Showing 1–10 of 31

Taxonomy Code	Specialty	Notes
`207L00000X`	Orthopaedic Surgery	Primary specialty performing open fixation or excision of radial head/neck fractures.
`207RX0600X`	Orthopaedic Traumatology	Subspecialty focused on fracture care and complex upper extremity trauma.
`208000000X`	General Surgery	May be involved in settings without orthopedics present; less common for this procedure.
`2086S0102X`	Emergency Medicine	Typically provides initial evaluation and stabilization; not the operative surgeon but relevant to care pathway.
`364S00000X`	Physical Medicine & Rehabilitation	Manages postoperative rehab and functional recovery.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S52.11XA`	Displaced fracture of proximal radius, initial encounter for closed fracture	Common indication for open treatment when displacement or instability precludes closed management.
`S52.12XA`	Displaced fracture of proximal radius, initial encounter for open fracture	Indicates open fracture at the proximal radius requiring operative debridement and fixation.
`S52.10XA`	Fracture of upper end of radius, unspecified, initial encounter for closed fracture	Used when documentation does not specify head vs neck but an operative approach addresses proximal radius.
`S52.13XA`	Comminuted fracture of proximal radius, initial encounter for closed fracture	Comminution at the radial head/neck often necessitates excision of fragments or more complex fixation.
`S52.14XA`	Comminuted fracture of proximal radius, initial encounter for open fracture	Open, comminuted injuries requiring operative management and possible staged procedures.
`S52.191A`	Other fracture of head of radius, right side, initial encounter for closed fracture	Side-specific code for documentation and laterality reporting.
`S52.192A`	Other fracture of head of radius, left side, initial encounter for closed fracture	Side-specific left-sided diagnosis code.
`M25.831`	Other joint pain, right elbow	May be used in follow-up documentation for persistent pain after treatment.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`24665`	Open treatment of radial head or neck fracture, with or without internal fixation, with lateral incision at the elbow	Primary procedure for open treatment; this is the billed code for the described operative approach.
`24538`	Open treatment of proximal radial shaft fracture, with or without internal fixation	May be performed when fracture extends into the proximal radial shaft or requires additional fixation proximal to the radial neck.
`20680`	Removal of implant; deep (e.g., buried screw, pin)	Performed in a later procedure if screws or wires placed during fixation require removal due to pain, infection, or hardware failure.
`27132`	Partial excision or resection of bone (note: example code from hip region)	Data not applicable; use only codes specific to upper extremity for excision.
`73620`	Radiologic examination, elbow; 2 views	Common intra- and postoperative imaging for initial diagnosis and immediate postoperative verification of reduction and hardware placement.
`99024`	Postoperative follow-up visit, global surgery problems routine	Used by the surgeon to report routine postoperative visits related to the global surgical package.

OpenPayer