CPT 23120Surgery

Claviculectomy partial

CPT 23120 covers partial surgical removal of the collarbone (clavicle), typically performed to treat conditions like arthritis, fractures that won't heal, or tumors affecting part of the clavicle.

Showing rates for

National Average

Base Medicare rate

$586.12

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

7.39

PE RVU (NF)

9.26

MP RVU

1.47

Total RVU

18.12

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

NCCI bundling edits

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Billing tips

Document the exact portion and length of clavicle removed (medial, middle, or distal third; centimeters excised) as this affects code selection and supports medical necessity
Impact: Prevents downcoding or denials; ensures $586.12 payment versus potential denial requiring appeal
Always append LT or RT modifier for laterality as this is a paired anatomical structure; many payers auto-deny claims missing laterality modifiers
Impact: Prevents automatic denial and 30-45 day payment delay for resubmission
When billing for infection-related partial claviculectomy, link appropriate ICD-10 codes (M86.x series for osteomyelitis) to demonstrate medical necessity
Impact: Strengthens medical necessity documentation and reduces review rate by up to 40%
If arthroscopic distal clavicle excision (29824) was attempted but converted to open approach, bill 23120 with modifier 53 only if procedure was discontinued; bill 23120 alone if completed via open approach
Impact: Prevents unbundling denials while ensuring appropriate payment for the actual procedure performed
For tumor excision requiring partial claviculectomy, ensure pathology report is available and diagnosis code specifies benign vs. malignant to support procedure necessity
Impact: Reduces medical review requests by 60% and supports appeal if claim is denied for medical necessity
Verify global period (90 days for 23120) before billing E/M services during postoperative period; use modifier 24 for unrelated E/M visits
Impact: Prevents incorrect bundling of E/M services worth $75-200 during the global period

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23120 in 2025?

The 2025 Medicare national average reimbursement for CPT 23120 is $586.12 for both facility and non-facility settings. This rate is based on 18.12 total RVUs (7.39 work RVU, 9.26 PE RVU, 1.47 MP RVU) multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary based on geographic location and MAC locality adjustments.

What is the difference between CPT 23120 and 23125?

CPT 23120 describes partial claviculectomy where only a portion of the clavicle is removed, while CPT 23125 describes complete claviculectomy where the entire clavicle is excised. The key documentation requirement is the operative note clearly stating the extent of bone removed and the anatomical portions preserved. Code selection must accurately reflect the actual procedure performed.

Can CPT 23120 be billed with arthroscopic shoulder procedures?

CPT 23120 can be billed with arthroscopic shoulder procedures if they are distinct and separate services, but careful attention to NCCI edits is required. Arthroscopic distal clavicle excision (29824) should not be billed with 23120 as they represent different approaches to the same anatomical target. Use modifier 59 when billing 23120 with other shoulder arthroscopy codes if procedures are truly separate and distinct, with clear documentation supporting both.

What diagnosis codes support medical necessity for CPT 23120?

Common supporting ICD-10 codes include M19.01x (primary osteoarthritis of acromioclavicular joint), M86.41x-M86.47x (chronic osteomyelitis of clavicle), S42.0xxK (clavicle fracture nonunion), C40.01 (malignant neoplasm of scapula and long bones of upper limb), D16.01 (benign neoplasm of scapula and long bones), and M25.51x (pain in shoulder). Documentation must clearly link the diagnosis to the specific portion of clavicle being removed.

Is CPT 23120 a bilateral procedure and how do I bill it?

CPT 23120 is inherently a unilateral procedure requiring laterality modifiers (LT or RT). If bilateral partial claviculectomy is performed during the same operative session, append modifier 50 to indicate bilateral procedure. Most payers reimburse bilateral procedures at 150% of the unilateral rate ($879.18 for Medicare in 2025), though some may require separate line items with LT and RT modifiers instead of modifier 50.

What is the global period for CPT 23120?

CPT 23120 has a 90-day global surgical period. This means routine postoperative care for 90 days following the procedure is included in the surgical fee and should not be billed separately. E/M services during the global period are only separately billable if unrelated to the surgery (modifier 24) or if complications require return to the operating room (modifiers 78 or 79).

How should I code partial claviculectomy performed for distal clavicle osteolysis in a weightlifter?

Partial claviculectomy for distal clavicle osteolysis should be coded with CPT 23120, appropriate laterality modifier (LT or RT), and diagnosis code M89.541 or M89.542 (osteolysis, right or left shoulder). Document the patient's weightlifting activities as contributing factors, evidence of conservative treatment failure, and imaging showing osteolytic changes. This condition is common in athletes and weightlifters and requires clear documentation of symptom duration and failed conservative management.