CPT code 24115: Excision of bone cyst of the humerus with autograft

Key takeaways

CPT code 24115 describes excision or curettage of a bone cyst or benign tumor of the humerus, with autograft.

The descriptor includes obtaining the graft, so the harvest is bundled into 24115 and is never billed as a separate code.

CPT 24110, 24115 and 24116 differ only by graft: no graft, autograft, allograft. None of them involves bone cement or internal fixation.

A lesion in the proximal humerus is coded from the 23150, 23155 and 23156 family instead, so confirm the humeral segment first.

CPT 24115 carries a 90-day global period, so a return to the operating room in that window needs modifier 78 or 79.

Practice management software like Pabau submits 24115 claims through the Claim.MD clearinghouse, with built-in CPT and ICD-10 catalogs to reduce coding errors.

CPT code 24115 is a surgical procedure code maintained by the American Medical Association (AMA). It sits in the Musculoskeletal System section, under Excision Procedures on the Humerus (and/or Elbow). The full official descriptor reads: Excision or curettage of bone cyst or benign tumor, humerus; with autograft (includes obtaining graft).

Two pathological presentations account for most claims under this code. The first is a cystic lesion of the humerus, typically a solitary (unicameral) or aneurysmal bone cyst. The second is a benign neoplasm at the same site, such as an enchondroma or an osteochondroma. Both weaken the bone, so the surgeon curettes the lesion and then packs the resulting defect.

What sends the claim to 24115 rather than a neighboring code is the graft. The surgeon harvests bone from the patient, usually from the iliac crest or a local site, and fills the cavity with it. The parenthetical “includes obtaining graft” means that harvest is already paid for inside 24115, which is the single most commonly missed rule in this family.

CPT 24110 vs 24115 vs 24116: Key differences

These three codes describe the same operation on the same bone. They diverge on one variable only, which is what went into the defect after the lesion came out. Nothing else separates them, and no other technique detail moves the claim from one to the next.

The operative report has to name the graft material for the coder to land on the right code. A note that says “the cavity was packed with graft” supports 24110 as easily as 24115, and payers read the ambiguity in their own favor. If the surgeon took bone from the patient, the note should say autograft and name the donor site.

Downcoding runs in the other direction too. Coders who default to 24110 whenever the graft type is unstated leave the harvest work unpaid, even though the surgeon performed it. Both errors trace back to the same root cause, which is a descriptor the note never mirrors. Guidance on reading these families sits in AAPC’s orthopedic coding reference.

Related CPT codes in the humerus excision family

CPT 24115 sits inside a grid with two axes. One axis is the bone segment involved. The other is the graft. Fix the segment first, then pick the graft column, and the code follows without guesswork.

Read down the grid and the pattern is hard to miss. Each site gets three codes, and the third digit of the graft column never changes meaning. Sports medicine practices and orthopedic groups bill these codes often. That grid belongs in the billing workflow as a lookup, rather than in a coder’s memory.

Why bone cement and internal fixation are not in this family

A persistent piece of misinformation circulates online, and it is worth naming directly. Several reference sites describe 24115 as the version of 24110 performed “with methyl methacrylate and internal fixation”. No code in the 24110 to 24126 range carries either element in its descriptor.

Methyl methacrylate appears in the CPT code set only inside unrelated spine device descriptors. Internal fixation appears as a separate add-on in the femur family, at 27358, and it does not extend to the humerus. So a surgeon who cements a humeral defect and applies a plate does not thereby land on 24115. The graft is what the code pays for.

Practically, that matters at two moments. A coder reading a cement-and-plate operative note must code the reconstruction from its own descriptors rather than reaching for 24115. And an auditor who finds 24115 on a claim will look for a graft in the note, not for an implant log.

Applicable modifiers for CPT code 24115

Modifier selection for CPT code 24115 follows standard orthopedic surgical rules. Each modifier serves a specific claims purpose. Applying the wrong one, or omitting one that is required, risks a denial or a compliance flag.

Always verify modifier requirements against current payer-specific policies. Prior to surgery, conduct insurance eligibility verification to confirm coverage and any modifier restrictions the payer applies to orthopedic surgical codes.

ICD-10 codes commonly paired with CPT 24115

Every CPT 24115 claim needs a supporting ICD-10-CM diagnosis code that establishes medical necessity. The paired diagnosis has to match the pathology documented in the operative and pathology reports. Payers, Medicare included, will deny the claim if the linked diagnosis does not describe a bone cyst or benign tumor of the humerus.

Note that the M85.4 series covers solitary cysts and the M85.5 series covers aneurysmal cysts. Coders who reach for a similar-looking M85.3 code land on osteitis condensans instead, which will not support this procedure. Verify all diagnosis codes against the current CDC/NCHS ICD-10-CM tables before submitting, since the tables are updated each October.

For physical therapy clinics and orthopedic practices, post-surgical coding carries a basic compliance requirement. The diagnosis code has to match both the clinical documentation and the current ICD-10-CM edition. Use a crosswalk tool such as CrossCoder to validate CPT-to-ICD-10 medical necessity pairings before submission.

Medicare reimbursement rate for CPT code 24115

Medicare reimbursement for CPT 24115 comes from the CMS Physician Fee Schedule. The schedule multiplies Relative Value Units (RVUs) by a geographic adjustment factor and the annual conversion factor. Rates vary by locality. The figures below are approximate national averages for 2026. Verify them against the current CMS PFS lookup before using them for contract negotiations or budget planning.

Use the FastRVU 2026 RVU lookup to obtain current work, practice expense, and malpractice RVU components adjusted to your geographic locality. Part of the work value in 24115 reflects the graft harvest, which is why it sits above 24110 and above the allograft code 24116.

Facility vs non-facility reimbursement

When CPT 24115 is performed in a hospital outpatient department or ASC, the facility bills Medicare separately for its costs. The physician receives only the professional component, which is the lower facility rate. When the same procedure happens in an office-based surgical suite, the practice absorbs the overhead, so Medicare pays the higher non-facility rate. Most orthopedic excision procedures of this complexity are performed in a facility setting.

2026 fee schedule update

The 2026 CMS conversion factor reflects the annual RVU-to-dollar multiplier that CMS sets each November for the following calendar year. No code-specific descriptor changes were noted for 24115 in 2026. The conversion factor adjustment still moves the dollar reimbursement for every surgical code. Confirm the current factor through the CMS PFS lookup before finalizing contract rates or patient estimates.

Practices managing high volumes of orthopedic billing benefit from connecting claims straight to a clearinghouse. Electronic claims via Claim.MD let orthopedic billing teams submit CPT 24115 with built-in CPT and ICD-10 catalogs. Those catalogs remove a manual keying step before the claim reaches the payer.

Global period and post-operative billing rules for CPT 24115

CPT code 24115 carries a 90-day global period. Routine post-operative care by the operating surgeon is already included in the surgical fee. That covers the day of surgery through the 90th post-operative day, so those visits cannot be billed separately. Knowing which services are bundled, and which are billable, keeps the practice clear of overpayments and recoupment requests.

Several services are bundled into the global period. They include the immediate post-operative care on the day of surgery and all related post-op visits through day 90. Wound care and suture removal are bundled, as is any complication managed without a return to the operating room. Care of the graft donor site is bundled too, since the harvest belongs to the same code.

Services billable separately during the global period include:

• A new, unrelated problem treated by the same surgeon (bill with modifier 24 appended to the E&M code)
• An unrelated surgical procedure performed during the global window (bill the new procedure with modifier 79)
• A return to the operating room for a complication (bill with modifier 78; payment is limited to the intraoperative component)
• Services by a different physician (no modifier needed; they bill under their own NPI)

Tracking electronic remittance advice through the 90-day window helps practices spot a payer that is bundling a legitimate separate service into the global period. An ERA may show a denial code for global period inclusion on a service that should be separately payable. The operative date and the modifier documentation then become the basis for the appeal.

Documentation requirements for CPT 24115

Claims for CPT 24115 that survive a payer audit share one characteristic. The operative report makes the code selection self-evident. Auditors reviewing this code look for two things above all: the humeral segment treated, and an explicit autograft with a named donor site. When either is missing, the reviewer has grounds to downcode to 24110.

• Preoperative diagnosis: bone cyst or benign tumor of the humerus, with laterality and the segment involved (shaft or distal humerus)
• Postoperative diagnosis: confirmed pathology, or a reference to the pending pathology specimen
• Procedure performed: an explicit statement of excision or curettage of the lesion, followed by grafting of the resulting defect
• Graft type: the word autograft, stated plainly, rather than a bare mention of “graft” that a reviewer can read either way
• Graft harvest: the donor site (iliac crest, proximal ulna, or local humeral bone), the approach used to reach it, and the volume of bone taken
• Donor site closure: how the harvest site was managed, which shows the harvest genuinely happened in this session
• Specimen submission: a pathology report confirming the benign nature of the excised tissue, which supports the ICD-10 medical necessity coding
• Anesthesia type: general or regional, required for anesthesia crosscoding
• Surgeon’s attestation: a signed operative report with date and time stamps

The harvest detail is worth dwelling on. Because 24115 includes obtaining the graft, that work is never billed on its own line, and coders sometimes conclude it does not need documenting. The opposite is true. The harvest description is the evidence that separates 24115 from 24110 and from the allograft code 24116.

Whoever handles the claim should have the operative note in front of them before it goes out. A graft field on the surgical superbill should offer three choices, none, autograft, or allograft. It stops a coder from defaulting to 24110 when the note supports 24115.

Common billing errors and audit risks for CPT 24115

Most reference pages for this code stop at the descriptor. The five errors below are the ones that generate rejections and audit findings for 24115. They are drawn from standard OIG audit guidance and AAPC coder community reporting.

Upcoding to 24115 without a documented autograft

Billing 24115 when the operative report does not describe an autograft is a false claim risk. Two versions of this show up in audits. In the first, no graft was placed at all, which makes 24110 the correct code. In the second, the surgeon used donor bone, which is 24116 and carries a lower value than the autograft code.

Payers now run pre-payment edits that compare 24115 against the rest of the record. A claim with no harvest described in the note, and no donor site mentioned anywhere, invites a request for records.

Unbundling the graft harvest

The phrase “includes obtaining graft” inside the 24115 descriptor settles this one. Reporting a bone graft harvest code such as 20900 or 20902 alongside 24115 for the same session is unbundling, and NCCI edits catch it. The harvest is part of the 24115 service rather than an add-on to it.

Effective denial management workflows should include a bundling check before submission. For guidance on the denial codes that come back when an edit fires, see the denial codes in medical billing reference.

Coding a proximal humerus lesion from the wrong family

A cyst in the proximal humerus belongs to 23150, 23155, or 23156, not to the 24000 series. The technique may be identical, so the note reads as a match for 24115 to anyone skimming for the word autograft. The anatomy is what decides the family, and it decides first.

This one rarely produces a clean denial. It produces a paid claim that an audit later reverses, which is the more expensive outcome. Ask the coder to confirm the segment from the operative note or the imaging report before the code is chosen.

Missing or late diagnosis code

Submitting CPT 24115 with a placeholder ICD-10 code, such as M79.9 for an unspecified soft tissue disorder, is a medical necessity failure. The diagnosis has to reflect the confirmed or probable pathology documented at the time of surgery.

Practices whose revenue cycle management workflow separates billing from clinical documentation hit this often. The claim goes out before the pathology report comes back. Consider holding the 24115 claim until pathology is confirmed, particularly when the working diagnosis is uncertain.

Global period violations

Billing a post-operative visit inside the 90-day window without modifier 24 is a consistent audit finding for orthopedic codes. The same applies when nothing in the record shows the visit was unrelated to the surgery. Train front-desk and billing staff to flag every visit within 90 days of a 24115 procedure date for physician review before billing.

Maintain medical billing compliance protocols that spell out which modifier scenarios your practice supports and how each must be documented. A clean claim submission for a global-period visit carries the modifier before the claim reaches the clearinghouse, not after a denial.

How claims software keeps graft coding accurate

In most orthopedic practices, the 24110-to-24116 decision happens twice. The surgeon dictates the note, and days later a coder reads it and picks a code. Between those two moments the graft detail either survives in writing or it does not, and the claim value turns on that.

Practice management software like Pabau closes that distance by keeping the operative record and the claim in one system. The surgical note template can require the graft type and the donor site before it is signed, so the coder is never guessing from prose. Claims management software then carries built-in CPT and ICD-10 catalogs, which means 24115 and M85.421 are picked from a list rather than typed from memory.

Claims go out electronically through the Claim.MD clearinghouse, and remittance advice comes back into the same patient record. So when a 24115 claim is questioned, the note, the diagnosis, the submission date, and the payer response all sit together. Your billing team answers the records request in minutes instead of rebuilding the file from three systems.

Streamline surgical billing with Pabau

Pabau’s claims management software connects to the Claim.MD clearinghouse. Submit CPT 24115 and related orthopedic codes electronically, with built-in code catalogs that cut errors before claims reach the payer.

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Conclusion

CPT 24115 comes down to two questions, asked in order. Which segment of the humerus held the lesion, and what filled the defect afterwards. Answer the first wrong and you are in the 23150 family. Answer the second wrong and you are on 24110 or 24116.

The graft harvest is the detail that gets lost. It is bundled into the code and never billed separately. It still has to appear in the operative note, because it is the only evidence that 24115 was the right choice.

Practices that bill this family regularly do better by building the graft question into the note template rather than catching it at the coding desk. Book a demo to see how Pabau keeps orthopedic documentation, claims, and remittance in one place.

Continue your research

Need to understand how the claims submission process works end to end? Pabau’s Claim.MD clearinghouse guide explains how orthopedic and surgical claims move from code entry to ERA receipt.

Looking for guidance on what makes a claim clean before it reaches the payer? Understanding the 837 electronic claim file covers the EDI transaction format, required data elements, and how submission errors trigger rejections.

Want a framework for managing post-surgical denials? Pabau vs Office Ally clearinghouse comparison reviews how denial tracking and resubmission workflows differ across clearinghouse partners.

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