CPT 23125Surgery

Claviculectomy total

CPT code 23125 covers the complete surgical removal of the clavicle (collarbone). This is a major surgical procedure typically performed for severe trauma, malignancy, or chronic osteomyelitis that cannot be managed with partial removal.

Showing rates for

National Average

Base Medicare rate

$705.48

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

9.64

PE RVU (NF)

10.2

MP RVU

1.97

Total RVU

21.81

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

NCCI bundling edits

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Billing tips

Document total versus partial claviculectomy clearly in operative report with specific anatomic endpoints (SC joint to AC joint)
Impact: Prevents downcoding to 23120 (partial claviculectomy, $464.95) which represents $240.53 revenue loss
For tumor cases, obtain and document pathology report confirming malignancy or aggressive benign lesion requiring total resection
Impact: Strengthens medical necessity appeal; oncologic indications have highest approval rates (>95%)
When performed for trauma, document failed conservative management or specific contraindications to ORIF with plates
Impact: Reduces denial rate from 15-20% to under 5% for traumatic indications
Bill facility and professional components separately when performed in hospital setting
Impact: Ensures capture of both $705.48 professional fee and facility technical component
For modifier 22 claims, submit detailed operative note highlighting extra work with comparison to typical case duration and complexity
Impact: Increases modifier 22 approval rate from 30% to 65-70%; potential $141-$212 additional revenue
Verify pre-authorization requirements as many payers classify this as requiring prior approval due to high cost and permanent functional impact
Impact: Prevents 100% payment denial; retrospective authorization is difficult to obtain

Common denials

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Frequently asked questions

What is the Medicare reimbursement for CPT code 23125 in 2025?

Medicare pays $705.48 for CPT 23125 (total claviculectomy) in 2025 based on the national average rate. This applies to both facility and non-facility settings. The code carries 21.81 total RVUs (9.64 work RVUs, 10.2 PE RVUs, and 1.97 malpractice RVUs).

What is the difference between CPT 23120 and 23125?

CPT 23120 is for partial claviculectomy (removing only a portion of the collarbone), while 23125 is for total claviculectomy (complete removal of the entire clavicle from sternoclavicular to acromioclavicular joint). The distinction is critical as 23125 reimburses at $705.48 versus $464.95 for 23120, a difference of $240.53.

What diagnosis codes support medical necessity for total claviculectomy?

Common supporting diagnoses include malignant neoplasm of clavicle (C40.01-C40.02), chronic osteomyelitis of clavicle (M86.61-M86.62), pathologic fracture due to neoplasm (M84.51), post-radiation osteonecrosis (M87.18), and severe comminuted fractures (S42.01-S42.02) when fixation is not feasible. Documentation must justify why total resection is necessary.

Can CPT 23125 be billed bilaterally?

Yes, though bilateral total claviculectomy is extremely rare. When performed bilaterally during the same operative session, append modifier 50 for 150% reimbursement ($1,058.22 total). More commonly, bilateral procedures would occur in staged fashion during separate encounters, each billed separately without modifier 50.

Does CPT 23125 require prior authorization?

Most commercial payers and Medicare Advantage plans require prior authorization for CPT 23125 due to its high cost, permanent functional impact, and the availability of less invasive alternatives. Medicare traditional (Part B) does not require prior authorization but may conduct post-payment review. Always verify with the specific payer.

What modifiers are commonly used with CPT 23125?

Common modifiers include RT/LT for laterality, modifier 22 for increased complexity with extensive tumor or revision cases, modifier 50 for bilateral procedures, modifier 62 for co-surgery when vascular or thoracic surgeons assist, and modifier 59 to prevent bundling with other shoulder reconstruction procedures performed simultaneously.

How many RVUs is CPT code 23125 worth in 2025?

CPT 23125 has 21.81 total RVUs in 2025, consisting of 9.64 work RVUs, 10.2 practice expense RVUs (both facility and non-facility), and 1.97 malpractice RVUs. At the 2025 conversion factor of 32.3465, this equals $705.48 Medicare reimbursement.