CPT code 24358 – Open elbow tenotomy and debridement

Key takeaways

CPT code 24358 is an open elbow tenotomy with debridement of soft tissue and/or bone for epicondylitis, with no tendon repair or reattachment.

A laterality modifier (RT or LT) belongs on virtually every claim, and leaving it off is the most preventable denial in this code family.

Payers typically want 3 to 6 months of failed conservative treatment on file before approving 24358, such as physical therapy, NSAIDs, or corticosteroid injections.

CMS lists 14.97 total RVUs for 24358 in 2026, with the same practice expense RVU in facility and office settings.

Pabau, the practice management platform we build, submits 24358 claims through Claim.MD and posts remittances back against each claim, so a short payment surfaces early.

CPT code 24358: definition and official descriptor

CPT code 24358 reports an open tenotomy of the lateral or medial elbow with debridement of soft tissue and/or bone. The tendon is not repaired or reattached. It sits in the Musculoskeletal System section of the CPT code set, under humerus and elbow repair and revision procedures. In addition, the American Medical Association maintains it as part of the 24357-24359 family, where each code describes a more involved elbow procedure.

The parenthetical “(eg, epicondylitis, tennis elbow, golfer’s elbow)” confirms that both lateral and medial epicondylitis are valid indications. The defining words are “debridement” and “open”. So, the operative note must show an incision and excision of degenerated tendon tissue or bone, with no tendon repair or reattachment afterward.

Procedure overview: what the open tenotomy involves

Knowing the surgical steps helps coders check that the operative note supports 24358 and not a simpler or harder nearby code. The procedure unfolds in four stages.

1. Incision: First, the surgeon makes a direct incision over the lateral or medial epicondyle, typically 3-5 cm, to expose the tendon origin.
2. Tendon release (tenotomy): Then the extensor carpi radialis brevis (ECRB) tendon (lateral) or the flexor-pronator mass (medial) is released or divided at the epicondyle.
3. Debridement: Next, degenerated, fibrotic, or calcified tissue is excised from the tendon and, where needed, from the underlying bone. In fact, this debridement is the defining service of 24358, so it is never reported with a separate debridement code.
4. Closure: Finally, the wound is irrigated and closed in layers. Overall, the operative report must record each step, including what was found and removed.

If the surgeon also repairs the tendon or reattaches it to the epicondyle in the same session, the correct code is 24359, not 24358. Because the two look alike, mixing them up is a common coding error in this family.

Indications for open elbow tenotomy surgery

CPT 24358 applies when conservative management has failed and surgery is medically necessary. Also, payers use Local Coverage Determinations (LCDs) issued by Medicare Administrative Contractors to define what “failed conservative care” means for this procedure.

• Lateral epicondylitis (tennis elbow): The primary indication. ICD-10-CM codes M77.11 (right) or M77.12 (left) must match the operative site. Use M77.10 only when laterality can’t be determined, which is rare in a surgical record.
• Medial epicondylitis (golfer’s elbow): The secondary indication. Code M77.01 (right) or M77.02 (left). Likewise, surgeons treating the medial epicondyle follow the same charting standard.
• Failed conservative treatment: Most LCDs require 3 to 6 months of documented conservative care before approving surgery. For example, that care often means physical therapy, NSAIDs, activity modification, or corticosteroid injections. The exact threshold varies by MAC jurisdiction.

Practices that bill 24358 should attach the conservative treatment timeline to every prior authorization request. Also, keep a copy in the chart for audits.

CPT 24357, 24358, and 24359: choosing the right code

The 24357-24359 code family covers a spectrum of elbow tenotomy procedures. Picking the wrong code is a common audit finding because the procedures look alike but differ a lot in what the operative note must show.

The operative note is the deciding document, and two questions about it settle the code. A needle or probe inserted without an incision points to 24357. An incision with debridement of tendon tissue or bone and no tendon repair points to 24358. Once the surgeon repairs the tendon or reattaches it to bone, the code is 24359.

ICD-10 diagnosis code pairings

Every 24358 claim requires a diagnosis code that establishes medical necessity. The CMS ICD-10-CM tabular list specifies laterality at the 5th character for epicondylitis codes. So coders must select the site-specific code, not the unspecified default.

The diagnosis code’s laterality must match the CPT modifier (RT or LT). For example, a claim with M77.11 (right) and modifier LT is a clear mismatch that payers will deny automatically. Also, document the operative site in the preoperative note, the consent form, and the operative report.

Modifier guidance for elbow tenotomy billing

CPT 24358 requires a laterality modifier on virtually every commercial and Medicare claim. As a result, filing without one is the single most avoidable denial cause in this code family.

When billing modifier 59, confirm the NCCI edit pairing before filing. However, incorrect use of 59 to override a valid bundle is an audit red flag and can trigger False Claims Act scrutiny.

Medicare reimbursement for CPT code 24358

Reimbursement for CPT code 24358 varies by location. The place of service doesn’t change it, because CMS lists the same practice expense RVU in every setting. The CMS Physician Fee Schedule lookup tool provides the national payment rates. So check current figures there before quoting reimbursement to a patient or payer.

2026 fee schedule RVU values

The table below reflects the 2026 Medicare Physician Fee Schedule national values for CPT 24358. Next, each RVU component is adjusted by the geographic practice cost index (GPCI) for the practice location, then multiplied by the 2026 conversion factor. Finally, use the FastRVU lookup tool to work out the payment for your ZIP code.

The work RVU for 24358 is 6.49 in both settings. CMS also lists the same practice expense RVU of 7.20 for facility and non-facility claims, so the setting doesn’t change the physician fee. Values change with each annual fee schedule rule, so check the CMS lookup before quoting a dollar amount.

Global surgery period and postoperative care

CPT 24358 carries a 90-day global surgery package. As a result, routine postoperative care related to the surgery is bundled into the single surgical fee for 90 calendar days after the procedure date.

• Bundled services (cannot bill separately): Office visits related to normal recovery, suture removal, routine wound checks, and uncomplicated postoperative care within the 90-day window.
• Modifier 78 unlocks separate billing: A related complication, such as wound dehiscence or infection, may send the patient back to the operating room. Bill the return procedure with modifier 78.
• Modifier 79 for unrelated surgery: Modifier 79 marks an unrelated surgical procedure done within the 90-day global period, which allows separate payment.
• E&M visits during the global period: An office visit for a new, unrelated condition can be billed separately with modifier 24 on the E&M code.

Billing a routine follow-up visit without a modifier inside the 90-day window creates an overpayment that payers will recover on audit. So, train billing staff to flag all visits for patients who had 24358 in the prior 90 days.

Prior authorization requirements

Most commercial payers and many Medicare Advantage plans require prior authorization before approving CPT 24358. Because authorization criteria are set by each payer’s LCD or medical policy and vary by MAC jurisdiction, there is no universal standard. So, medical billing compliance programs at orthopedic practices should build prior auth workflows into the scheduling process, not the pre-billing process.

Payers often ask for these records before they approve the surgery:

• Office notes giving the symptom start date and length (usually 3 to 6 months minimum, but check the threshold with the specific payer)
• Physical therapy records showing visits, methods used, and results
• Records of at least one corticosteroid injection and its result, where clinically appropriate
• Imaging (MRI or ultrasound) showing tendinopathy or partial tearing where the payer requires imaging evidence
• Function check, such as grip strength tests, effect on daily tasks, and work limits

If authorization is denied, request the payer’s LCD or clinical criteria document. Then compare the patient’s chart against it line by line before filing an appeal. Moreover, an appeal that answers each criterion with a direct chart citation is far more persuasive than a generic letter.

Documentation requirements for a clean claim

Submitting a clean claim for CPT 24358 depends on whether the operative note supports both the code choice and the medical need. Auditors reviewing 24358 claims focus on two documents: the operative report and the pre-operative chart.

Operative note requirements

• Procedure stated plainly as “open tenotomy” or “open release” with the word “incision,” since percutaneous language disqualifies 24358
• Anatomical site and laterality: “lateral epicondyle, right elbow” or “medial epicondyle, left elbow”
• Description of tissue debridement, stating what was removed (degenerated tendon fibers, calcific deposits, fibrotic tissue) and from which structure
• Confirmation that the tendon was not repaired or reattached, because repair or reattachment language moves the claim to 24359
• Wound closure details and estimated blood loss

Pre-operative documentation

• Conservative treatment timeline: dates, methods, length, and patient response for each step
• Notes on lost function that support the need for surgery
• Imaging reports, where required by payer policy
• Signed consent naming the exact procedure

Pabau’s claims management software pre-fills each claim from the patient record, where the authorization details and clinical notes already sit. As a result, it cuts the back-and-forth that drives denials on surgical codes.

Common claim denial reasons and how to avoid them

CPT 24358 claims face a predictable set of denial triggers. However, most are avoidable at the pre-billing stage with the right workflow controls. Denial management workflows for surgical codes should tackle each of these root causes before the claim leaves the practice. When a denial does come back, the denial codes on the remittance tell you which cause applies.

Facility vs. non-facility billing settings

CPT 24358 is almost always done in a facility setting, either a hospital outpatient department (HOPD) or an ambulatory surgery center (ASC). Reporting the wrong place of service is a place-of-service error, not a switch to a different RVU. In addition, CMS lists the same practice expense RVU of 7.20 in every setting for this code.

Submitting POS 11 (office) for a procedure done in an ASC or HOPD is a place-of-service error. The physician fee for 24358 is the same either way. However, the claim misstates where the surgery happened and won’t match the facility’s own claim. The AAPC CPT code reference lists 24358 as a major surgical procedure that needs facility-level equipment and sterile technique. So, physician office billing is not appropriate. Finally, use electronic remittance advice processing to check that each payment posted matches the expected fee schedule amount.

Billing CPT 24358 with Pabau

Most 24358 denials trace back to records kept apart from the claim: the authorization number, the therapy timeline, and the operative note. For this reason, Pabau keeps those records on the patient file, next to the claim.

Next, claims go out through the Claim.MD clearinghouse, with an eligibility check you can run on the date of service. Finally, electronic remittance advice posts back against each claim, so a short-paid line stands out before it ages.

Streamline your orthopedic billing workflows

Pabau connects to Claim.MD to submit CPT 24358 claims electronically, check eligibility in real time, and process electronic remittance advice without manual rework. See how orthopedic and sports medicine practices use Pabau to reduce claim denials.

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Conclusion

Once the operative note shows an open debridement with no tendon repair, choosing CPT code 24358 is the easy part. However, denials come from what surrounds it. Watch for a missing RT or LT modifier, an authorization that lapsed before surgery, or a follow-up visit billed inside the 90-day window.

So put those checks into scheduling rather than the denial queue. Confirm the conservative-care timeline and the authorization before the surgery is booked, then flag the patient for the next 90 days. In addition, Pabau’s medical billing workflows keep those checks on one patient record. Book a demo to see how Pabau keeps surgical claims clean from authorization to remittance.

Continue your research

Need to understand how claims move from submission to payment? Medical claims clearinghouse overview explains the role of clearinghouses in electronic claim submission and ERA processing.

Tracking down specific denial reason codes on a 24358 rejection? Denial codes in medical billing covers CARC and RARC codes with corrective action guidance.

Want to check eligibility before the surgery date? Insurance eligibility verification walks through real-time eligibility checks and how to read benefit responses for surgical codes.

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