Exc/crtg b1 cst/tum hum agrf
CPT 24115 covers the surgical removal of a bone cyst or benign tumor from the upper arm bone (humerus), including aggressive curettage (scraping) of the affected area. This procedure addresses painful or structurally weakening bone lesions in the upper arm.
This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
NCCI bundling edits
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Billing tips
Document aggressive curettage technique explicitly in operative report to justify 24115 over simpler excision codes
Impact: Prevents downcoding to 23190 (cyst removal without aggressive curettage) which pays $195 less
Always append LT or RT modifier; claims without laterality modifiers are auto-denied by Medicare and commercial payers
Impact: Prevents 100% claim denial and 30-45 day payment delay while resubmitting corrected claim
When bone grafting is performed, bill separately with 20900-20902 based on graft source; this is not bundled with 24115
Impact: Additional $150-400 reimbursement depending on graft type and source (autograft vs allograft)
For pathologic fractures, ensure fracture treatment code (24500-24516) is also billed if internal fixation performed beyond simple curettage
Impact: Can add $400-900 to total reimbursement when fracture stabilization documented as distinct service
Use modifier 22 for lesions >5cm, multiple lesions, or cases requiring extended surgical time with detailed operative report including time comparison
Impact: Can increase payment $146-293 (20-40%) when supporting documentation clearly exceeds typical case complexity
Submit pathology report with claim for tumor cases to support medical necessity and prevent denials for experimental/investigational determinations
Impact: Reduces denial rate from 12-15% to 2-3% and accelerates payment processing by 10-15 days
Common denials
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