CPT 23140Surgery

Removal of bone lesion

CPT 23140 covers the surgical removal of a bone lesion (abnormal growth or damaged tissue) from the shoulder area. This procedure addresses benign tumors, cysts, or other abnormal bone formations that may cause pain or limited function.

Showing rates for

National Average

Base Medicare rate

$554.74

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

7.12

PE RVU (NF)

8.56

MP RVU

1.47

Total RVU

17.15

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

NCCI bundling edits

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Billing tips

Document exact anatomical location (clavicle, scapula, or proximal humerus) in operative note header and body to prevent anatomical ambiguity denials
Impact: Prevents 15-20% of initial denials related to insufficient anatomical specificity; required for most commercial payer audits
Include lesion size measurements in centimeters and depth documentation; lesions >5cm may justify modifier 22 for increased complexity
Impact: Modifier 22 with proper documentation can increase reimbursement by $110-$220 above base rate of $554.74
Bill facility vs non-facility appropriately based on site of service; both rates are identical at $554.74 for 2025, but Place of Service code must match claim form
Impact: POS code mismatches trigger automatic denials even though rates are equal; corrected claims delay payment 30-45 days
Verify pathology report confirms bone lesion (not soft tissue) before final claim submission; discrepancies between CPT and pathology cause post-payment recoupment
Impact: Post-payment audits finding soft tissue pathology result in 100% recoupment ($554.74) plus potential fraud investigation
When bone grafting is performed during same session, use 20900-20902 separately only if autograft harvested from separate site; allografts typically bundle
Impact: Properly unbundled autograft harvest adds $150-$300 additional reimbursement; incorrect unbundling triggers RAC audits
For lesions requiring reconstruction with hardware (plates/screws), separately bill appropriate fixation codes (23515-23525) as these typically don't bundle with 23140
Internal fixation codes can add $400-$800 when medically necessary and properly documented as distinct from lesion removal

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23140 in 2025?

The 2025 Medicare national average reimbursement for CPT 23140 is $554.74 for both facility and non-facility settings. This rate is based on a total RVU of 17.15 multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement may vary by geographic location due to locality adjustments.

Does CPT 23140 require a laterality modifier?

Yes, CPT 23140 requires either the LT (left side) or RT (right side) modifier to indicate which shoulder was treated. Failure to append the appropriate laterality modifier will result in automatic claim rejection by most payers, including Medicare.

Can CPT 23140 be billed with bone grafting codes?

Bone grafting codes (20900-20902) can be billed separately with CPT 23140 only when autograft is harvested from a separate surgical site (such as iliac crest). Allograft or bone void fillers placed into the lesion cavity typically bundle with 23140 and should not be separately reported without documentation of distinct work.

What is the difference between CPT 23140 and 23145?

CPT 23140 is for excision of a bone lesion from the shoulder area (clavicle, scapula, or proximal humerus), while CPT 23145 is for excision with autograft, obtained from same operative field. The distinction is whether bone graft harvest required additional work at the same anatomical site versus simple cavity packing.

How do you justify medical necessity for CPT 23140?

Medical necessity for CPT 23140 is justified through documentation of symptomatic lesions causing pain or functional limitation, radiographic evidence of lesion growth, pathologic fracture risk, diagnostic uncertainty requiring tissue diagnosis, or lesions with aggressive imaging features. Imaging reports, physical examination findings, and failed conservative management should be documented.

What are the work RVUs for CPT code 23140?

CPT 23140 has a work RVU of 7.12 for 2025. The total RVU is 17.15, which includes 7.12 work RVU, 8.56 practice expense RVU, and 1.47 malpractice RVU. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

When should modifier 22 be used with CPT 23140?

Modifier 22 should be appended to CPT 23140 when the procedure requires significantly greater work than typical, such as unusually large lesions (>5cm), extensive bone reconstruction, complex anatomical location requiring extended dissection, or significant intraoperative complications. Documentation must specifically compare the actual work to a standard procedure and justify the additional time and complexity.