CPT code 24342 – Reinsertion of ruptured biceps or triceps tendon

Key takeaways

CPT Code 24342 covers open reinsertion of a ruptured biceps or triceps tendon at the distal site, not proximal or arthroscopic repairs.

Tendon graft sits inside the descriptor, so the operative report documents it but the code stays the same.

Modifier LT or RT belongs on every claim, and missing laterality is the top denial reason for this code.

The code carries a 090-day global period, so routine follow-up in those 90 days is already paid for.

A charge template that locks laterality and the approved diagnosis codes to 24342 prevents most denials before submission.

CPT Code 24342: quick reference

CPT Code 24342 is the procedure code for reinsertion of a ruptured biceps or triceps tendon at its distal attachment, with or without tendon graft. It belongs to the Repair, Revision, and/or Reconstruction subsection of the musculoskeletal chapter, which runs from 24300 to 24498. The table below carries the billing identifiers coders need before a claim goes out.

What CPT Code 24342 covers for distal biceps tendon repair

CPT Code 24342 covers open reinsertion of a completely ruptured tendon at its distal attachment point. That means the biceps at the radial tuberosity, or the triceps at the olecranon. The code applies whether the surgeon bridges the repair with an autograft or an allograft. Tendon graft sits inside the descriptor, so it generates no separate procedure code.

Fixation method is bundled too. Cortical button fixation, bone tunnel technique, and suture anchor fixation all count as part of the reinsertion when the approach is open. Billing a separate fixation code alongside 24342 typically triggers a National Correct Coding Initiative (NCCI) edit.

• Biceps tendon: Complete rupture at the distal insertion on the radial tuberosity, repaired open with anatomic reattachment
• Triceps tendon: Complete rupture at the distal insertion on the olecranon, repaired open with reattachment
• Tendon graft (optional): Autograft or allograft used to augment the repair, documented in the operative report but not coded separately
• Fixation hardware: Cortical button, bone tunnel, or suture anchor, all bundled within the code

The descriptor reads “biceps or triceps”, so both tendons fall under the same code. When the operative report documents a triceps reinsertion, 24342 is still correct. No triceps-specific CPT code exists for this distal procedure.

What CPT 24342 does not cover: adjacent and excluded codes

CPT Code 24342 does not cover proximal biceps repairs, arthroscopic approaches, or procedures where the tendon was never avulsed from its distal attachment. Reaching for 24342 when one of the codes below describes the surgery is a common upcoding risk for orthopedic billers.

The 24340 versus 24342 decision is the most audit-sensitive one in this code family. CPT 24340 describes tenodesis of the biceps tendon at the elbow and carries a separate procedure designation. 24342 applies only where the tendon has completely ruptured and is reinserted at its distal attachment. If the operative report documents a tenodesis rather than a reinsertion, 24342 is the wrong code.

Documentation requirements for a 24342 claim

Every 24342 claim that reaches a clean claim submission standard needs an operative report confirming four things. Those are complete tendon rupture, the distal insertion site, the fixation method used, and whether a graft was harvested or procured. A missing element hands a Recovery Audit Contractor a straightforward basis for recoupment.

• Rupture confirmation: The operative note and pre-operative imaging must document complete avulsion from the distal insertion point
• Anatomic site: The report states distal biceps or distal triceps explicitly, because proximal repairs are coded differently
• Fixation method: Cortical button, bone tunnel, or suture anchor technique, all bundled but all recorded
• Graft documentation: Record the graft source, its preparation, and its intraoperative use. Verify with the payer before billing any separate HCPCS code for graft material
• Laterality: The operative report states left or right arm explicitly, which drives the LT or RT modifier on the claim

The charge itself should carry the CPT code, the laterality modifier, and the primary ICD-10-CM diagnosis code on a single line. Entering them as separate items raises the risk of modifier-linkage errors at the clearinghouse.

Correct modifiers for CPT Code 24342

CPT Code 24342 requires a laterality modifier on every claim. Medicare and most commercial payers use it to confirm which arm was operated on and to track bilateral billing. The table below covers the modifiers most often applied to this code and when each one fits.

Modifiers explain the circumstances around a procedure. They never change what the procedure was, so each one needs documentation in the record that supports it.

ICD-10 diagnosis codes that support CPT Code 24342

Medical necessity for CPT Code 24342 rests on the linked diagnosis code, which has to document a complete tendon rupture at the distal site. The ICD-10-CM code library lists the laterality-specific options coders choose between. Pairing a sprain or partial-tear code with an operative report describing complete avulsion creates a medical necessity mismatch, and the claim is denied.

Acute traumatic injuries use the S46-series codes with the 7th-character encounter qualifier, A for initial and D for subsequent. Spontaneous degenerative ruptures use the M66-series codes instead. The split matters because some payers apply different medical necessity criteria to acute and chronic presentations. The diagnosis should describe the patient’s condition at the time of surgery, not the mechanism from weeks earlier.

Medicare reimbursement and fee schedule for CPT Code 24342

Reimbursement for CPT Code 24342 under the Medicare Physician Fee Schedule (MPFS) varies by locality and setting. The values below are national averages, and actual payment shifts with the Geographic Practice Cost Index (GPCI) for your MAC jurisdiction. Verify current rates with the CMS MPFS lookup tool before quoting a figure to a patient.

RVU values and dollar conversions change with every annual MPFS update. Confirm the current conversion factor and the GPCI-adjusted rate for your locality before you post an expected payment against the charge.

Global period and post-operative billing rules

CPT Code 24342 carries a 090-day global surgical period. Routine post-operative care is bundled into the procedure payment for the 90 days following surgery. In that window the operating surgeon cannot separately bill office visits for wound checks, suture removal, or standard follow-up on the repair.

• Bundled, no separate charge: Routine post-op visits, wound care, splint or brace checks, and standard X-rays confirming fixation
• Separately billable with modifier 24: Evaluation and management for an unrelated condition at a post-op visit
• Separately billable with modifier 79: An unrelated surgical procedure by the same surgeon inside the 90-day window
• Separately billable with modifier 78: A return to the operating room for a complication of the original repair

Physical therapy delivered by a therapist rather than the operating surgeon is billed separately as well. Each exception needs documentation showing it falls outside the original procedure, and the timeline below maps them across the 90 days.

Prior authorization requirements by payer type

Traditional Medicare fee-for-service does not require prior authorization for CPT Code 24342. Medicare Advantage plans and most commercial insurers do, and their requirements vary by plan. Verify them with each patient’s plan before the procedure is scheduled, not after.

Where authorization is required, the documentation package usually needs imaging that confirms complete tendon rupture, with the radiologist’s read attached. Add the surgeon’s notes on failed conservative management, where that applies to a non-acute presentation, plus the operative plan. Checking authorization rules at the eligibility step, before scheduling, is where these denials get prevented.

Common claim denial reasons and how to prevent them

Claims for CPT Code 24342 are denied most often over preventable documentation and modifier errors. Each pattern below has a straightforward fix that belongs in the practice’s charge capture workflow rather than in the appeals queue.

Sorting denials by CARC code before working appeals shows which ones started at charge capture. A single coder chasing individual denials clears less than a charge template that stops the common errors leaving the practice at all.

Billing CPT Code 24342 in practice management software

Orthopedic and sports medicine practices that bill CPT Code 24342 regularly should configure their charge capture templates before the next claim is raised. The aim is to make the right modifier, the right diagnosis code, and the right fee schedule amount the default instead of the exception.

• Default modifier template: Pre-load LT and RT on the 24342 charge line and block submission until one is selected
• Diagnosis code linking: Map M66.821, M66.822, S46.211A, and S46.212A as the approved diagnoses, and flag other diagnoses for coder review
• Fee schedule setup: Enter the current MPFS rate and your contracted commercial rates by payer, so expected reimbursement is calculated at charge entry
• NCCI edit integration: Set claim scrubbing rules to flag any add-on code that would trigger an NCCI edit alongside 24342
• Prior auth tracking: Link the authorization number to the charge line at scheduling, and hold the claim until that number is populated

Practice management software like Pabau handles this configuration at the practice level. Its claims software for practices keeps CPT codes, diagnosis codes, and modifier rules on one charge capture screen. The values your team enters travel with the claim to submission, and the remittance advice comes back mapped to the original charge line. A standardized 24342 charge template then pays for itself in reduced denial rework.

Keep modifiers and diagnoses on every surgical charge

Pabau holds CPT codes, ICD-10 diagnoses, and modifier rules on one charge capture screen. Your team confirms the laterality modifier on a 24342 charge line before the claim is submitted.

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Conclusion

CPT Code 24342 rewards precision in three places: the laterality modifier, the choice between 24340 and 24342, and the operative report that carries medical necessity. Practices that settle those at charge capture stop paying for them at appeal.

That work belongs upstream, in the charge template and the operative note. Book a demo to see how Pabau keeps modifiers and diagnosis codes attached to surgical charges before they reach the payer.

Continue your research

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