CPT code 24650 – Closed radial head or neck fracture treatment without reduction

Key takeaways

CPT code 24650 covers closed treatment of a radial head or neck fracture when the provider performs no manipulation (reduction).

A reduction moves the claim to 24655, and open treatment through an incision moves it to 24665 or 24666.

The 90-day global period bundles routine follow-up and the first cast or splint, so only a replacement cast is billed separately.

Many payers require RT or LT on this paired-site code, so check payer policy and match the modifier to the documented side.

The 2026 Medicare national rate is about $302 non-facility and $259 facility, from 9.03 and 7.74 total RVUs.

CPT code 24650: official descriptor and procedure overview

CPT code 24650 carries the official AMA descriptor: Closed treatment of radial head or neck fracture; without manipulation. “Closed” means no surgical incision was made. “Without manipulation” means the provider did not perform a fracture reduction. If either condition is absent, a different code applies.

The radial head sits at the proximal end of the radius, just below the elbow joint. Fractures here are among the most common elbow injuries, typically from a fall on an outstretched hand. CPT code 24650 applies when the provider confirms the fracture, judges it stable enough for conservative care, and treats it without repositioning the fragments.

CPT 24650 vs 24655 vs 24665: choosing the right code

The clinical decision point between 24650 and 24655 is manipulation. Manipulation means the provider physically repositioned the fracture fragments during the encounter. The clinical note must explicitly state whether manipulation was or was not performed.

Upcoding to 24655 when the note only documents observation, splinting, and return-to-care instructions is a billing error that payers and auditors flag. Billing 24650 when the note describes a reduction under-bills the visit. The documentation must settle the question on its own, with no inference required.

• 24650: Stable fracture, sling or splint applied, no reduction. Note states “no manipulation performed” or equivalent language.
• 24655: Displaced or unstable fracture, provider performed closed reduction. Note documents the manipulation and post-reduction imaging.
• 24665: Open treatment through an incision, which includes internal fixation or radial head excision when performed. Use 24666 instead when the radial head is replaced with a prosthesis.

The two questions below settle the choice in order, starting with whether the fracture site was opened.

What 24650 covers and what it excludes

CPT code 24650 is a global fracture care code. It bundles the initial fracture assessment and routine follow-up within the 90-day global period into a single payment, so knowing its boundaries prevents unbundling errors.

Included in the 24650 global bundle:

• Initial fracture evaluation and decision to manage conservatively
• Application and removal of the first cast or splint
• All routine follow-up visits within the 90-day global period

Excluded and separately billable (when documented appropriately):

• E&M visit on the same day as fracture care, when it addresses a separate, documented problem (requires modifier -25)
• Decision for surgery at a subsequent visit (modifier -57)
• New problems arising during the global period that are unrelated to the fracture
• X-rays and their interpretation
• Replacement casts or splints applied later in the global period, using codes such as 29065, 29075 or 29125

Modifiers that apply to 24650

Modifier selection for CPT code 24650 affects whether the claim is accepted. Start with laterality, then check the modifiers below against the clinical context.

A note on modifier -25: payers require that the medical record for the same-day E&M clearly documents the separate problem. A visit note that only documents the fracture and then bills an E&M alongside 24650 will be denied or reversed on audit. The separate problem needs its own documented assessment and plan.

Pairing 24650 with cast and splint codes

CPT fracture treatment codes include the application of the first cast or splint, so the initial cast is not billed alongside 24650. Cast codes come into play only for a replacement cast during the 90-day global period. They also apply when the provider applying the cast does not treat the fracture.

• 29065 (long arm cast, shoulder to hand): Not billed for the initial cast, because 24650 includes it. A replacement long arm cast during the global period may be billed.
• 29075 (short arm cast, elbow to finger): Same rule. The first cast is part of 24650, and only a replacement cast is separately billable.
• 29125 (short arm splint, static): Same rule for the initial splint. A provider who applies a splint without treating the fracture bills 29125 instead of 24650.
• Modifier -59: It does not unbundle the initial cast from 24650. Reserve -59, or its XE, XS, XP and XU subsets, for a distinct service the documentation supports.

Before billing a replacement cast, check the current NCCI edit pair for 24650 with 29075 or 29125. CMS updates the NCCI edit tables every quarter.

ICD-10 codes that support a radial head or neck fracture claim

Every CPT code 24650 claim needs an ICD-10-CM diagnosis code that confirms a radial head or neck fracture. Radial head fractures sit in S52.12-, and radial neck fractures sit in S52.13-. The 7th character for the encounter type is mandatory, and a claim without it or with the wrong one will reject.

Use 7th character A while the patient receives active treatment for the fracture. Switch to D for routine-healing follow-up visits during the global period. Character S is for sequelae, the late effects that remain after the fracture itself has healed. The S52.00- codes describe the upper end of the ulna, so they never support a radial head claim.

Medicare reimbursement and RVU values for CPT code 24650

CPT code 24650 reimbursement varies by place of service, geographic locality, and the annual CMS conversion factor. The figures below are 2026 Medicare national values, priced with the $33.4009 conversion factor for clinicians outside a qualifying APM. Verify current rates in the CMS Physician Fee Schedule lookup tool before billing, as rates change each year and differ by locality.

The non-facility rate is higher because practice expense RVUs are larger when the procedure is performed in the physician’s office. In hospital outpatient and ASC settings, the facility rate applies and the facility bills separately for overhead. Use a current RVU lookup tool to confirm values for your billing year.

The 90-day global surgery period

The global surgery period for CPT code 24650 is 90 days under CMS rules, beginning the day after the procedure date. This global period bundles routine follow-up care into the original payment, so separate billing for included services will be denied.

• Included in the global period: All routine post-fracture visits and the application and removal of the first cast or splint.
• Separately billable during the global period: Treatment of a new, unrelated condition, X-rays, replacement casts, and complications requiring a return to the operating room. A later reduction that escalates care to 24655 or 24665 is also billable, with modifier -58 for a staged or related procedure.
• Commercial payer variation: Some commercial payers do not follow CMS global surgery rules. Verify your payer contract, because certain plans use shorter global periods or define bundled services differently.

Documentation that supports a 24650 claim

Weak documentation sits behind many CPT code 24650 denials. Each element below maps to a specific denial risk when it is missing. A clearinghouse can catch format errors, but it cannot add a missing no-reduction statement to the note.

• Imaging report: X-ray or CT confirming a radial head or neck fracture. The imaging report must identify the anatomical site and laterality. Without it, payers may deny for lack of medical necessity.
• No-manipulation statement: The clinical note must explicitly state that no fracture manipulation was performed. Phrases like “fracture well-aligned, no reduction required” or “treated conservatively without manipulation” are acceptable. Absence of this language invites an audit flag.
• Laterality: Right or left must be documented in the note and must match the laterality modifier on the claim. A mismatch between the two invites a denial.
• Fracture care versus E&M: If billing only 24650, the note should read as a fracture care note rather than an E&M visit. When an E&M with modifier -25 is billed too, the separate problem needs its own documented history, exam, and plan.
• Provider credentials: The treating provider must be credentialed with the payer and their NPI must appear on the claim. Group billing must follow payer-specific assignment rules.

Common denial reasons and how to avoid them

CPT code 24650 denials cluster around a predictable set of errors, and most are preventable before the claim goes out. Effective denial management workflows track these patterns by code and payer, so staff can fix root causes instead of reworking individual claims. Review common denial codes to understand payer messaging on remittance advice.

Payer-specific rules and prior authorization

Traditional Medicare fee-for-service generally does not require prior authorization for closed fracture care under CPT code 24650. Medicare Advantage plans follow their own authorization rules, and requirements vary by plan and region. Commercial payers and state Medicaid managed care organizations have even more variable policies.

• Medicare FFS: Prior auth typically not required. Some payers may request clinical documentation retrospectively if a claim triggers medical necessity review.
• Medicare Advantage: Check each plan’s authorization requirements before the encounter. Some MA plans require auth for fracture care beyond the initial visit.
• Commercial and Medicaid managed care: Authorization requirements vary by state and payer. Confirm requirements at the time of insurance eligibility verification before the patient is seen.
• Radiology documentation: Some payers require a copy of the imaging report on file before approving fracture care claims. Submit proactively rather than waiting for a denial.

With payer rules this varied, a clean claim on the first submission depends on preparation. Check authorization, laterality and the 7th character before the claim goes out.

How Pabau keeps 24650 claims tied to the fracture note

In many orthopedic practices, a 24650 claim passes through three hands. The provider writes the fracture note, and a coder reads it for reduction status and laterality. A biller then rekeys the codes into a separate clearinghouse portal. Each handoff is a chance for RT to become LT or for the no-reduction statement to go unchecked.

Pabau, the practice management platform we build, keeps the appointment, the clinical note and the invoice in the same patient record. Its orthopedic claims software handles electronic claim submission and tracking through Claim.MD, so your team sends and follows each claim without leaving Pabau.

The coder reviews the documentation where it lives. A missing laterality or reduction statement surfaces before submission, not after a denial lands.

Keep fracture claims tied to the clinical note

Pabau keeps scheduling, clinical notes and invoices in one patient record. Your team submits and tracks claims electronically through Claim.MD.

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Conclusion

Code 24650 only when the note says, in plain words, that no reduction was performed. A documented reduction makes the claim 24655, and an incision moves it to 24665 or 24666. That single sentence in the note decides which code, and which payment, the claim can support.

Build your pre-billing check around it. Confirm RT or LT where the payer asks for it, and an S52.12- or S52.13- code with the right 7th character. Then make sure no cast code charges for the first cast.

Book a demo to see how Pabau keeps the fracture note and the claim in one record, so your coder checks both before submission.

Continue your research

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Want to understand what happens after a claim denies? Denial management in healthcare explains how to build a systematic appeals process that recovers revenue on fracture care codes.

Looking for a billing compliance reference? Medical billing compliance covers documentation standards, audit triggers, and payer contract alignment for orthopedic and musculoskeletal billing.

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