CPT 23145Surgery

Removal of bone lesion

CPT code 23145 covers the surgical removal of a bone lesion (abnormal growth or damaged area) from the shoulder area. This includes removing benign or malignant bone tumors, cysts, or other abnormal bone tissue.

Showing rates for

National Average

Base Medicare rate

$691.57

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

9.4

PE RVU (NF)

10.07

MP RVU

1.91

Total RVU

21.38

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

NCCI bundling edits

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Billing tips

Document exact lesion location (clavicle, scapula, or proximal humerus) and size in centimeters in operative report
Impact: Missing anatomic specificity causes 35-40% of initial denials; detailed documentation supports medical necessity and prevents downcoding
Verify pathology report confirms bone lesion diagnosis and include pathology CPT code on same claim when performed
Impact: Pathology confirmation strengthens medical necessity; coordinating surgical and pathology billing prevents $150-300 in denied pathology charges
For lesions requiring bone grafting, bill separately using appropriate bone graft codes (20900-20902) with modifier 59 if not bundled
Impact: Proper bone graft coding can add $200-500 in additional reimbursement; verify CCI edits before billing separately
Use modifier 22 only when lesion exceeds 5cm or requires extensive bone reconstruction; submit comparison documentation
Impact: Well-documented modifier 22 claims can increase reimbursement by $138-276 (20-40% increase), but poorly documented claims face 70% denial rate
Bill in facility setting when appropriate to optimize reimbursement; both facility and non-facility rates are identical at $691.57 for 23145
Impact: Unlike many codes, 23145 has identical facility and non-facility rates, so setting choice should be based on clinical appropriateness and overhead costs
Ensure pre-authorization is obtained for Medicare Advantage and commercial payers before scheduling; most require prior auth for orthopedic surgical procedures
Missing prior authorization results in 100% claim denial for many MA plans; obtaining auth prevents $691.57 payment loss and patient balance billing issues

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 23145 in 2025?

The 2025 Medicare national average reimbursement for CPT 23145 is $691.57 for both facility and non-facility settings. This rate is based on 21.38 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement may vary based on geographic location and payer-specific fee schedules.

What does CPT code 23145 include in the surgical procedure?

CPT 23145 includes the complete removal of a bone lesion from the shoulder girdle (clavicle, scapula, or proximal humerus), including surgical exposure, curettage or excision of the lesion, and closure. It does not include bone grafting, extensive reconstruction, or treatment of malignant tumors requiring wider resection, which may require different codes.

How many RVUs is CPT code 23145 worth in 2025?

CPT 23145 has 21.38 total RVUs in 2025, consisting of 9.4 work RVUs, 10.07 practice expense RVUs (both facility and non-facility), and 1.91 malpractice RVUs. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

What modifiers are commonly used with CPT 23145?

The most common modifiers for CPT 23145 are LT/RT (laterality indicators required for all claims), modifier 50 (bilateral procedures), modifier 22 (increased complexity for large or difficult lesions), modifier 58 (staged procedures), and modifier 59/XS (distinct procedural service when billed with other shoulder procedures).

Does CPT 23145 require prior authorization from insurance?

Most Medicare Advantage plans and commercial insurers require prior authorization for CPT 23145 as it is a surgical procedure. Traditional Medicare typically does not require prior auth, but medical necessity must still be documented. Always verify authorization requirements with the specific payer before scheduling surgery to avoid claim denials.

Can CPT 23145 be billed with bone graft codes?

Yes, bone graft codes (20900-20902) can often be billed separately with CPT 23145 when bone grafting is performed to fill the defect after lesion removal. However, you must check CCI edits and may need modifier 59 to indicate a distinct service. Documentation must clearly support the medical necessity of the bone graft procedure.

What is the difference between CPT 23145 and 23140?

CPT 23145 is for removal of a bone lesion from the shoulder girdle, while CPT 23140 is for excision or curettage of a bone cyst or benign tumor of the clavicle or scapula. Code selection depends on the specific pathology and extent of the procedure. CPT 23145 generally applies to more complex lesions requiring complete excision, while 23140 may apply to simpler cyst curettage.