CPT 24116Surgery

Exc/crtg b1 cst/tum hum algr

CPT 24116 covers the surgical removal of a bone cyst or tumor from the upper arm bone (humerus), including bone grafting if needed. This is a major orthopedic procedure typically performed to treat benign or malignant bone lesions in the upper arm.

Showing rates for

National Average

Base Medicare rate

$850.07

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

Work RVU

12.23

PE RVU (NF)

11.57

MP RVU

2.48

Total RVU

26.28

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document graft source explicitly (autograft vs allograft) and harvest site if autograft used
Impact: Prevents downcoding to 24110 (excision without graft, $588.33); protects $261.74 differential in Medicare payment
Include pathology report confirmation and pre-operative imaging in claim documentation packet
Impact: Reduces medical necessity denials by 65-80%; establishes tumor size and characteristics justifying surgical approach
Bill separately for bone graft harvesting (20900-20902) when autograft obtained from separate site with modifier 59
Impact: Additional $150-300 reimbursement for iliac crest harvest; requires clear documentation of separate incision and site
Verify tumor size and document whether intralesional (curettage) or marginal/wide excision performed
Impact: Affects code selection between 24110, 24115, and 24116; ensures correct code with 26.28 RVUs for allograft/autograft procedures
Use modifier 22 with detailed operative note when tumor exceeds 5cm or requires cortical window reconstruction with plating
Impact: Can increase reimbursement by $170-255 when properly documented with size measurements and additional time/complexity
Submit under correct facility vs non-facility status; both rates identical at $850.07 for 24116 but setting affects global period billing
Impact: Ensures proper postoperative visit reimbursement and prevents claim rejections for place of service mismatches

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 24116 in 2025?

The 2025 Medicare national average reimbursement for CPT 24116 is $850.07 for both facility and non-facility settings. This is based on 26.28 total RVUs (12.23 work RVU, 11.57 practice expense RVU, 2.48 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 24116 and 24110?

CPT 24116 includes bone grafting (autograft or allograft) as part of the tumor excision procedure, while 24110 is excision without graft. Code 24116 reimburses at $850.07 versus lower payment for 24110. Use 24116 when the bone defect requires filling with graft material to restore structural integrity after tumor removal.

Can I bill CPT 24116 with a bone graft harvest code?

Yes, when autograft is harvested from a separate anatomical site (typically iliac crest), you can bill bone graft harvest codes 20900-20902 with modifier 59 in addition to 24116. The operative report must clearly document a separate incision, distinct site, and additional surgical work for the graft harvest to justify separate billing and avoid bundling denials.

What modifiers are required when billing CPT 24116?

Laterality modifiers LT (left) or RT (right) are mandatory for CPT 24116 to indicate which humerus was treated. Additional modifiers may include 22 (increased complexity), 59 (distinct procedural service), 78 (return to OR), or 80 (assistant surgeon) depending on specific case circumstances and payer requirements.

What documentation prevents denial of CPT 24116 claims?

Essential documentation includes pre-operative imaging showing tumor size and location, detailed operative report describing excision technique and defect size, explicit documentation of graft type and source, pathology report confirming diagnosis, and medical necessity justification for surgical intervention. Operative notes must specifically describe bone grafting to prevent downcoding to 24110.

How many RVUs is CPT code 24116 worth in 2025?

CPT 24116 has 26.28 total RVUs in 2025, consisting of 12.23 work RVUs, 11.57 practice expense RVUs (both facility and non-facility), and 2.48 malpractice RVUs. This represents significant relative value reflecting the complexity of bone tumor excision with grafting.

What diagnoses support medical necessity for CPT 24116?

Common supporting diagnoses include benign bone neoplasms (D16.01), unicameral bone cyst (M85.51), aneurysmal bone cyst (M85.51), enchondroma, fibrous dysplasia (M85.01), and giant cell tumor. Documentation must demonstrate tumor characteristics requiring surgical excision such as size, growth, pain, fracture risk, or functional impairment that conservative management cannot address.