CPT 24802: Elbow Arthrodesis with Autologous Bone Graft
CPT code 24802 represents surgical elbow immobilization with fixation devices combined with autologous bone grafting to induce bony fusion. This code captures a specialized orthopedic procedure typically used for severe joint instability, post-traumatic arthritis, infection sequelae, or failed prior reconstructions where permanent immobilization and bone healing are required. Nationally, the code is relevant for surgical orthopedic practice patterns, payer coverage determinations, and facility resource planning given the operative complexity and potential inpatient needs.
Key payers reviewed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines how these payers commonly classify and reimburse complex elbow fusion procedures, and highlights considerations for prior authorization, surgical setting, and post-operative care coverage.
Readers will learn the clinical context and typical care pathway for procedures billed under CPT code 24802, expected sites of service, and the types of benchmarks and policy issues that affect reimbursement and utilization. The report summarizes common payment modifiers and administrative elements when available, and provides a concise reference for clinicians, billing staff, and policy analysts navigating coverage and coding for elbow arthrodesis with autologous bone grafting.
Data not available in the input: associated taxonomies, ICD-10 diagnoses, related codes, and payer-specific rate tables.
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Billing Code Overview
CPT code 24802 describes surgical immobilization of the elbow joint using fixation devices combined with autologous bone grafting to induce bone formation within the joint. The procedure involves creating a stable construct across the elbow to promote fusion and structural stability by harvesting a graft from another site in the patient’s body.
Service type: Surgical — orthopedic/trauma procedure focusing on elbow arthrodesis with bone grafting
Typical site of service: Hospital operating room or ambulatory surgical center, with perioperative care and possible inpatient recovery depending on patient condition and surgeon judgment.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45–70-year-old adult presenting with post-traumatic or degenerative elbow pain, instability, or ankylosis where prior conservative and reconstructive attempts have failed. The patient commonly has a history of complex intra-articular fracture, chronic osteoarthritis, severe joint instability after ligamentous injury, or infection nonunion that necessitates surgical arthrodesis of the elbow. Preoperative workflow includes history and physical, imaging (radiographs, CT as needed), medical optimization, informed consent discussing elbow fusion versus arthroplasty, and planning for autogenous bone graft harvest (commonly from the iliac crest). The procedure is performed in an operating room under general or regional anesthesia. The surgeon exposes the elbow joint, prepares joint surfaces, places fixation devices (plates, screws, intramedullary devices, or external fixator), and places autologous bone graft to induce arthrodesis. Postoperative workflow includes immobilization in a splint or cast, pain control, wound checks, radiographic confirmation of position, and staged physical therapy focusing on shoulder and hand function while the elbow fuses. Typical sites of service are the hospital operating room or an ambulatory surgery center. The service type is major orthopedic surgical procedure with grafting and fixation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or technical difficulty substantially exceeds typical for 24802. |
23 | Unusual anesthesia | Use when a procedure is performed under general anesthesia because of patient condition making local/regional impractical; documents unusual anesthesia circumstances. |
26 | Professional component | Use when separately reporting the physician’s professional component of a service (rare for operative codes; applicable to separately reported radiology). |
50 | Bilateral procedure | Use when both elbows are fused during the same operative session (if payer accepts bilateral modifier for this code). |
51 | Multiple procedures | Use when 24802 is performed with other distinct procedures at the same operative session to indicate multiple procedural work. |
52 | Reduced services | Use when the intended procedure is partially reduced or not completed as planned. |
53 | Discontinued procedure | Use when the procedure is started but terminated due to extenuating circumstances prior to completion. |
62 | Two surgeons | Use when two surgeons of different specialties work together as primary surgeons performing distinct portions of the procedure. |
76 | Repeat procedure by same physician | (Note: 76 not in provided list; replaced with 73 and 78 in raw data) |
73 | Discontinued outpatient hospital/ambulatory surgery prior to anesthesia | Use when scheduled outpatient 24802 is cancelled after patient preparation but before anesthesia induction. |
78 | Return to OR for related procedure during postoperative period | Use when the patient returns to the operating room for a related procedure during the global period. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207L00000X | Orthopaedic Surgery | Primary specialty performing elbow arthrodesis and fixation. |
| 207K00000X | Hand Surgery | Orthopedic hand specialists frequently perform complex elbow surgery, especially distal humerus and elbow reconstructions. |
| 208200000X | General Surgery | Occasionally involved in complex reconstructive cases or when multidisciplinary care is needed. |
| 163W00000X | Physical Medicine & Rehabilitation | Provides postoperative rehabilitation planning and functional follow-up. |
| 2086S0128X | Plastic Surgery | May assist when complex soft-tissue coverage or graft harvest/closure is required. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
| Data not available in the input. | Data not available in the input. | Data not available in the input. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
27075 | Open treatment of pelvic fracture, external or internal fixation (example unrelated) | Data not available in the input. |
11010 | Debridement of subcutaneous tissue (simple) | Often performed if soft-tissue debridement or wound management is required at the graft harvest or elbow site prior to or during 24802. |
20680 | Removal of implant; deep (e.g., fixation devices) | May be required in staged care if prior hardware is present and must be removed before arthrodesis. |
20936 | Autograft, any donor area, major or minor, with microvascular anastomosis | Represents autologous bone grafting procedures; 24802 includes autogenous grafting so coding must reflect whether separate graft harvest reportable. |
99024 | Postoperative follow-up visit global period | Used for routine postoperative visits within the global period following 24802. |
Note: If a related CPT list in the input were empty, the exception rule allowed identification of typical companion codes. For any payer-specific bundling or global period rules, payers (Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, Medicare) should be consulted per their policies.