2025 CPT code 24516
(Active) Effective Date: N/A Revision Date: N/A Surgery - Fracture and/or Dislocation Procedures on the Humerus (Upper Arm) and Elbow Musculoskeletal System Feed
Open treatment of humeral shaft fracture with insertion of an intramedullary implant, with or without cerclage and/or locking screws.
Modifiers may be applied as per CPT guidelines. For example, modifier 50 (bilateral procedure) may be used if both humeri are affected, or modifier 76 (repeat procedure) might apply if the same physician performs a revision surgery.
Medical necessity for 24516 is established when conservative management fails to achieve adequate fracture reduction or stability, and when ORIF is deemed necessary to restore anatomical alignment, prevent complications (e.g., nonunion, malunion), and promote functional recovery.
The orthopedic surgeon is responsible for the entire procedure, from pre-operative planning and patient assessment to the surgical intervention itself, post-operative care, and follow-up. This includes making the incision, reducing the fracture, inserting the implant, and closing the wound.
In simple words: This code describes surgery to repair a broken humerus (upper arm bone). The surgeon makes an incision, realigns the broken pieces of bone, inserts a rod inside the bone to stabilize it, and may use wires or screws for extra support.The incision is then closed.
This CPT code encompasses the open surgical treatment of a fracture in the humeral shaft (the middle portion of the upper arm bone).The procedure involves an incision, dissection through subcutaneous tissue, exposure of the fracture site, reduction (realigment) of the fractured bone fragments, and insertion of an intramedullary implant (a rod inserted into the medullary canal of the bone).Additionally, cerclage wiring (a wire loop encircling the bone) and/or locking screws may be used for additional stabilization.Post-procedure, the surgical site is irrigated, hemostasis is achieved, and the incision is closed. Imaging is used to verify alignment.
Example 1: A patient presents with a comminuted (broken into multiple pieces) humeral shaft fracture following a high-energy trauma.Open reduction and internal fixation (ORIF) with an intramedullary rod is necessary for adequate stabilization and healing., A patient with an unstable humeral shaft fracture that is not responding to conservative management (casting, splinting) requires ORIF with an intramedullary rod and supplemental locking screws to achieve anatomical reduction and prevent further displacement., A patient sustains a humeral shaft fracture with significant bone comminution and displacement.ORIF using an intramedullary nail, cerclage wiring, and locking screws is performed to ensure adequate fracture stabilization and functional outcome.
* Preoperative and postoperative radiographic images demonstrating fracture location, displacement, and reduction.* Operative report detailing the surgical approach, reduction technique, implant used, and post-operative assessment.* Complete medical history including any relevant comorbidities.* Detailed description of the fracture (e.g., type, displacement, comminution) and any associated injuries.
** The use of cerclage wiring and/or locking screws is included in the code description.Separate codes for these components are not needed unless they are exceptionally extensive.