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CPT code 24640: Nursemaid's elbow, radial head subluxation2026 Medicare rate & RVUs in King County, WA

Reports manipulation to reduce a young child's radial head subluxation, commonly after traction on the arm, when the diagnosis is nursemaid's elbow.

CMS RVU26DEffective Oct 1, 2026One payment locality15 Medicare services in 2024

In King County, WA, Medicare pays $119.70 for 24640 in the office and $79.53 when it’s performed in a hospital or facility.

$119.70Office (non-facility)
$79.53Hospital or facility
+14.9%vs the national office rate ($104.21)

Check a contract rate as a % of Medicare · 24640 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 24640 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in King County, WA
  2. What 24640 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 24640 covers

This service covers a clinician's manipulation to reduce radial head subluxation in a young child, commonly after an adult pulls or lifts the child by the hand or forearm. A pediatrician, emergency physician, or orthopedist may perform the reduction in an office or emergency department. Typical maneuvers involve rotating the forearm and flexing the elbow; the clinician assesses the child afterward for restored use of the arm.

Select this code when the documented condition is radial head subluxation and the clinician performs the reduction, rather than treating an elbow dislocation or fracture. Document the history and examination supporting the diagnosis, the manipulation performed, and the child's response. Related postoperative visits are included for 10 days. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures at 50%. For bilateral treatment, modifier 50 is paid at 150%. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How King County, WA compares for 24640

Across 109 of 109 payment localities, the office rate for 24640 runs from $94.46 in Arkansas to $134.62 in San Benito County, CA. King County, WA pays $119.70. The RVUs are the same everywhere; the geographic indexes change the dollars.

24640 in King County, WA vs other payment areas
  1. King County, WA · this page$119.70
  2. Rest of Washington · Washington$107.42−$12.28
  3. Los Angeles, CA · California$116.28−$3.42
  4. Washington, DC area · District of Columbia$117.56−$2.14
  5. Miami, FL · Florida$110.29−$9.41
  6. Chicago, IL · Illinois$107.83−$11.87
  7. Manhattan, NY · New York$118.09−$1.61

Other areas in Washington first, then benchmark localities. Bars start at $0.

Every other payment area

24640 in every other Medicare payment locality
Payment localityOfficeFacility
AlaskaAlaska$127.51$92.65
AlabamaAlabama$95.56$66.91
ArkansasArkansas$94.46$66.34
ArizonaArizona$101.98$70.26
Bakersfield, CACalifornia$109.94$74.06
Chico, CACalifornia$109.69$73.81
El Centro, CACalifornia$109.70$73.82
Fresno, CACalifornia$109.69$73.81

24640 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$94.46

$127.51

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
24640 office rate range by state
State / territoryOffice rate rangeLocalities
AK$127.511
AL$95.561
AR$94.461
AZ$101.981
CA$109.69–$134.6229
CO$108.101
CT$110.221
DC$117.561
DE$103.441
FL$102.70–$110.293
GA$98.06–$105.782
GU$111.601
HI$111.601
IA$97.611
ID$98.091
IL$100.21–$107.954
IN$98.551
KS$97.181
KY$97.231
LA$97.08–$100.922
MA$107.63–$117.482
MD$105.16–$117.563
ME$98.44–$102.802
MI$99.19–$103.682
MN$104.341
MO$95.71–$101.283
MS$95.101
MT$104.211
NC$99.271
ND$102.821
NE$98.051
NH$106.421
NJ$111.69–$116.722
NM$99.611
NV$103.881
NY$100.46–$120.375
OH$98.911
OK$97.151
OR$103.27–$111.052
PA$99.07–$107.902
PR$104.851
RI$106.751
SC$99.211
SD$102.661
TN$97.571
TX$98.54–$107.578
UT$100.301
VA$102.48–$117.562
VI$104.851
VT$102.441
WA$107.42–$119.702
WI$100.031
WV$97.211
WY$103.601

See 24640 in every payment locality

How the 24640 rate is calculated

Each of 24640’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 24640

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.22

1.22 RVUs× 1.000 GPCI

Practice expense1.83

1.83 RVUs× 1.000 GPCI

Malpractice0.07

0.07 RVUs× 1.000 GPCI

Adjusted RVUs

3.1200

Conversion factor

$33.4009

Medicare rate

$104.21

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact King County, WA inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

2,350

Code
24640
Physician work
1.22
Practice expense
1.83
Malpractice
0.07

GPCI2026.csv

108

Locality
King County, WA
Physician work
1.050
Practice expense
1.227
Malpractice
0.817
Office calculation for 24640 in King County, WA
ComponentRVULocality factorAdjusted
Physician work1.22× 1.0501.2810
Practice expense1.83× 1.2272.2454
Malpractice0.07× 0.8170.0572
Total RVUs3.5836
Conversion factor× 33.4009

Office rate, King County, WA$119.70

Office: (1.22 × 1.05 + 1.83 × 1.227 + 0.07 × 0.817) × $33.4009 = $119.70

Facility: (1.22 × 1.05 + 0.85 × 1.227 + 0.07 × 0.817) × $33.4009 = $79.53

Open 24640 in the RVU calculator

Payment rules and modifiers for 24640

24640 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 24640

Nursemaid's elbow, radial head subluxation

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 24640

Nursemaid's elbow, radial head subluxation

10-day global period ends

Oct 11, 2026

Covers Oct 1, 2026 through Oct 11, 2026 (11 days).

Visit on Oct 31, 2026

After the global period ends: visits and procedures are billed normally.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

24640 without 50 · national office

$104.21

Nursemaid's elbow, radial head subluxation

24640-50 · Bilateral: 150%

$156.31

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

Codes related to 24640

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 24640
CodeHow it relatesOffice range, King County, WA
Used instead
24600Elbow reduction, without anesthesiaFor closed treatment of an elbow dislocation rather than radial head subluxation.$545.67
24605Elbow reduction, with anesthesiaFor closed elbow dislocation treatment requiring anesthesia, not nursemaid's elbow.No office rate
24650Radial fracture care, head or neck, no manipulationFor closed treatment of a radial head or neck fracture without manipulation.$350.61
24655Fracture reduction, with manipulationFor closed treatment of a radial head or neck fracture with manipulation.$612.97
Often billed with
73080Elbow X-ray, three or more viewsElbow radiographs may accompany evaluation when imaging is obtained for atypical symptoms or suspected injury.$39.29

How 24640 has changed in King County, WA

24640 · Office / nonfacility

$119.70

Effective 2026-10-01

The base rate is $4.29 higher than on 2025-10-01, moving from $115.41 to $119.70 (3.7%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $115.41changed to$119.70

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.25 changed to 1.22
    • Practice expense RVU 1.80 changed to 1.83
    • Malpractice RVU 0.08 changed to 0.07
    • Work GPCI 1.043 changed to 1.050
    • Practice expense GPCI 1.220 changed to 1.227
    • Malpractice GPCI 0.853 changed to 0.817

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $119.87changed to$115.41

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 1.82 changed to 1.80
    • Malpractice RVU 0.09 changed to 0.08

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $117.91changed to$119.87

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $119.58changed to$117.91

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.78 changed to 1.82
    • Malpractice RVU 0.10 changed to 0.09
    • Work GPCI 1.039 changed to 1.043
    • Practice expense GPCI 1.207 changed to 1.220
    • Malpractice GPCI 0.815 changed to 0.853

  5. January 1, 2023

    RVU23A

    $120.37changed to$119.58

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.77 changed to 1.78
    • Malpractice RVU 0.09 changed to 0.10
    • Work GPCI 1.036 changed to 1.039
    • Practice expense GPCI 1.194 changed to 1.207
    • Malpractice GPCI 0.776 changed to 0.815

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $118.45changed to$120.37

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.70 changed to 1.77

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $114.73changed to$118.45

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.55 changed to 1.70
    • Work GPCI 1.031 changed to 1.036
    • Practice expense GPCI 1.170 changed to 1.194
    • Malpractice GPCI 0.854 changed to 0.776

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $112.14changed to$114.73

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.53 changed to 1.55
    • Malpractice RVU 0.08 changed to 0.09
    • Work GPCI 1.027 changed to 1.031
    • Practice expense GPCI 1.146 changed to 1.170
    • Malpractice GPCI 0.931 changed to 0.854

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $111.19changed to$112.14

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.51 changed to 1.53

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $129.43changed to$111.19

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.92 changed to 1.51
    • Malpractice RVU 0.16 changed to 0.08
    • Work GPCI 1.026 changed to 1.027
    • Practice expense GPCI 1.151 changed to 1.146
    • Malpractice GPCI 0.713 changed to 0.931

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $147.84changed to$129.43

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.38 changed to 1.92
    • Malpractice RVU 0.20 changed to 0.16
    • Work GPCI 1.025 changed to 1.026
    • Practice expense GPCI 1.155 changed to 1.151
    • Malpractice GPCI 0.495 changed to 0.713

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $154.13changed to$147.84

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 2.51 changed to 2.38
    • Malpractice RVU 0.22 changed to 0.20

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $153.36changed to$154.13

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $153.07changed to$153.36

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 2.47 changed to 2.51
    • Practice expense GPCI 1.150 changed to 1.155
    • Malpractice GPCI 0.688 changed to 0.495

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $160.64changed to$153.07

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.83 changed to 2.47
    • Malpractice RVU 0.23 changed to 0.22
    • Practice expense GPCI 1.144 changed to 1.150
    • Malpractice GPCI 0.881 changed to 0.688

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $160.64

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$119.70$79.53RVU26D
2026-07-01$119.70$79.53RVU26C
2026-04-01$119.70$79.53RVU26B
2026-01-01$119.70$79.53RVU26A
2025-10-01$115.41$86.21RVU25D
2025-07-01$115.41$86.21RVU25C
2025-04-01$115.41$86.21RVU25B
2025-01-01$115.41$86.21RVU25A
2024-10-01$119.87$89.81RVU24D
2024-07-01$119.87$89.81RVU24C
2024-04-01$119.87$89.81RVU24B
2024-03-09$119.87$89.81RVU24AR
2024-01-01$117.91$88.35RVU24A
2023-10-01$119.58$89.31RVU23D
2023-07-01$119.58$89.31RVU23C
2023-04-01$119.58$89.31RVU23B
2023-01-01$119.58$89.31RVU23A
2022-10-01$120.37$90.20RVU22D
2022-07-01$120.37$90.20RVU22C
2022-04-01$120.37$90.20RVU22B
2022-01-01$120.37$90.20RVU22A
2021-10-01$118.45$88.87RVU21D
2021-07-01$118.45$88.87RVU21C
2021-04-01$118.45$88.87RVU21B
2021-01-01$118.45$88.87RVU21A
2020-10-01$114.73$88.13RVU20D
2020-07-01$114.73$88.13RVU20C
2020-04-01$114.73$88.13RVU20B
2020-01-01$114.73$88.13RVU20A
2019-10-01$112.14$86.12RVU19D
2019-07-01$112.14$86.12RVU19C
2019-04-01$112.14$86.12RVU19B
2019-01-01$112.14$86.12RVU19A
2018-10-01$111.19$85.61RVU18D
2018-07-01$111.19$85.61RVU18C
2018-04-01$111.19$85.61RVU18B
2018-01-01$111.19$85.61RVU18AR1
2017-10-01$129.43$93.08RVU17D
2017-07-01$129.43$93.08RVU17C
2017-04-01$129.43$93.08RVU17B
2017-01-01$129.43$93.08RVU17A
2016-10-01$147.84$98.22RVU16D
2016-07-01$147.84$98.22RVU16C
2016-04-01$147.84$98.22RVU16B
2016-01-01$147.84$98.22RVU16A
2015-10-01$154.13$101.00RVU15D
2015-07-01$154.13$101.00RVU15C
2015-04-01$153.36$100.50RVU15B
2015-01-01$153.36$100.50RVU15A
2014-10-01$153.07$101.58RVU14D
2014-07-01$153.07$101.58RVU14C
2014-04-01$153.07$101.58RVU14B
2014-01-01$153.07$101.58RVU14A
2013-10-01$160.64$104.59RVU13D
2013-07-01$160.64$104.59RVU13C
2013-04-01$160.64$104.59RVU13B
2013-01-01$160.64$104.59RVU13AR

Price 24640 for an earlier date of service

Where the King County, WA rate applies

King County, WA is a Medicare payment area, not a city. Our Census mapping connects it to 63 cities and communities in Washington. Some span more than one payment area; confirm with the service ZIP.

  • Seattle
  • Algona
  • Ames Lake
  • 24640 in Auburn · multiple payment areas
  • Baring
  • Beaux Arts Village
  • Bellevue
  • Black Diamond

Browse all communities in Washington

24640 billing questions

How is this different from an elbow dislocation code?

Use 24640 for radial head subluxation, commonly called nursemaid's elbow. Codes 24600 and 24605 describe closed treatment of an elbow dislocation, a different diagnosis.

Can this code be used for a radial head fracture?

No. For a radial head or neck fracture, select the fracture-treatment code that matches the treatment performed, such as 24650 or 24655.

Does the code include the reduction maneuver?

Yes. The manipulation to reduce the subluxation is the service represented by 24640; do not report a separate reduction code for that same maneuver.

What documentation supports reporting 24640?

Document findings consistent with radial head subluxation, the manipulation performed, and the child's response, such as return of comfortable arm use.

How does the 10-day global period affect follow-up?

Related postoperative visits during the 10-day global period are included in the procedure payment.

How is bilateral treatment reported?

For treatment of both elbows, modifier 50 is paid at 150%.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 24640PPRRVU2026_Oct_nonQPP.csv, line 2,350 (RVU26D)
Geographic factors for King County, WAGPCI2026.csv, line 108 (RVU26D)

Open CMS sourceHow we calculate rates

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