Billing code 24640: Nursemaid's elbowMedicare rate & RVUs
Reports manipulation to reduce a young child's radial head subluxation, commonly after traction on the arm, when the diagnosis is nursemaid's elbow.
Medicare pays $104.21 for 24640 nationally in the office and $71.48 in a hospital or facility. Local office rates run $94.46–$134.62.
Medicare rate · 24640
Nursemaid's elbow
Swap in your local Medicare rate.
- Work RVUs
- 1.22
- Total RVUs
- 3.12
- Global days
- 010
National rate · 2026
$104.21
Office setting, before claim adjustments.
See every locality for 24640 → · Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 10 sections
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.
Where 24640 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$94.46 to $134.62
109 of 109 payment localities
24640 rates by state
Office rate range in each state. Select a state to see its payment localities.
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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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $127.51 | 1 |
| AL | $95.56 | 1 |
| AR | $94.46 | 1 |
| AZ | $101.98 | 1 |
| CA | $109.69–$134.62 | 29 |
| CO | $108.10 | 1 |
| CT | $110.22 | 1 |
| DC | $117.56 | 1 |
| DE | $103.44 | 1 |
| FL | $102.70–$110.29 | 3 |
| GA | $98.06–$105.78 | 2 |
| GU | $111.60 | 1 |
| HI | $111.60 | 1 |
| IA | $97.61 | 1 |
| ID | $98.09 | 1 |
| IL | $100.21–$107.95 | 4 |
| IN | $98.55 | 1 |
| KS | $97.18 | 1 |
| KY | $97.23 | 1 |
| LA | $97.08–$100.92 | 2 |
| MA | $107.63–$117.48 | 2 |
| MD | $105.16–$117.56 | 3 |
| ME | $98.44–$102.80 | 2 |
| MI | $99.19–$103.68 | 2 |
| MN | $104.34 | 1 |
| MO | $95.71–$101.28 | 3 |
| MS | $95.10 | 1 |
| MT | $104.21 | 1 |
| NC | $99.27 | 1 |
| ND | $102.82 | 1 |
| NE | $98.05 | 1 |
| NH | $106.42 | 1 |
| NJ | $111.69–$116.72 | 2 |
| NM | $99.61 | 1 |
| NV | $103.88 | 1 |
| NY | $100.46–$120.37 | 5 |
| OH | $98.91 | 1 |
| OK | $97.15 | 1 |
| OR | $103.27–$111.05 | 2 |
| PA | $99.07–$107.90 | 2 |
| PR | $104.85 | 1 |
| RI | $106.75 | 1 |
| SC | $99.21 | 1 |
| SD | $102.66 | 1 |
| TN | $97.57 | 1 |
| TX | $98.54–$107.57 | 8 |
| UT | $100.30 | 1 |
| VA | $102.48–$117.56 | 2 |
| VI | $104.85 | 1 |
| VT | $102.44 | 1 |
| WA | $107.42–$119.70 | 2 |
| WI | $100.03 | 1 |
| WV | $97.21 | 1 |
| WY | $103.60 | 1 |
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
Swap in your local Medicare rate.
Work 1.22Practice expense 1.83Malpractice 0.07
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 24640
Nursemaid's elbow
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.
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
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).
24640 compared with similar codes
Compare codes
24640 vs 24600 vs 24605 vs 24650 vs 24655: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 24600Elbow reduction
- 24600 is for closed treatment of an elbow dislocation without anesthesia. Use 24640 when the diagnosis is radial head subluxation in a child.
- 24605Elbow reduction
- 24605 addresses closed treatment of an elbow dislocation requiring anesthesia; 24640 is for manipulation of nursemaid's elbow.
- 24650Radial fracture care
- 24650 is for a radial head or neck fracture treated without manipulation. Choose 24640 for radial head subluxation, not a fracture.
- 24655Fracture reduction
- 24655 treats a radial head or neck fracture with manipulation. The diagnosis for 24640 is subluxation, not fracture.
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% under the CMS bilateral rule supplied for this code.
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
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