CPT 23146Surgery

Removal of bone lesion

CPT code 23146 covers the surgical removal of a bone lesion (abnormal growth or tumor) from the shoulder area. This procedure involves cutting into the bone to remove the abnormal tissue.

Showing rates for

National Average

Base Medicare rate

$622.67

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

8.08

PE RVU (NF)

9.52

MP RVU

1.65

Total RVU

19.25

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Document the exact anatomical location (clavicle, scapula, or proximal humerus) and lesion size in centimeters to support medical necessity
Impact: Prevents denials for insufficient documentation; supports modifier 22 claims for unusually large lesions (potential $124-$311 additional reimbursement)
Include pathology report confirmation with the claim when available to substantiate the lesion diagnosis and surgical necessity
Impact: Reduces audit risk by 40-60% and supports appeals for initially denied claims
Code separately for bone graft (20900-20902) or bone graft substitute if used during reconstruction after lesion removal
Impact: Additional $150-$450 in reimbursement depending on graft type and size; use modifier 59 if necessary
Verify the facility vs. non-facility setting matches the actual place of service; both rates are identical at $622.67 for 23146
Impact: Eliminates payment discrepancies and prevents recoupment; ensures accurate payment at $622.67
Check National Correct Coding Initiative (NCCI) edits before billing with shoulder arthroscopy or other shoulder procedures
Impact: Prevents denials for bundling issues; appropriate use of modifier 59 can recover $300-$1,200 in otherwise denied services
Bill for surgical pathology examination (88305 or 88307) separately as it is not included in the surgical code
Impact: Additional $75-$200 in reimbursement for pathology services that are legitimately separate

Applicable modifiers

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 23146?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the Medicare reimbursement rate for CPT 23146 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 23146 is $622.67 for both facility and non-facility settings, based on 19.25 total RVUs and a conversion factor of 32.3465.

How many RVUs is CPT code 23146 worth?

CPT 23146 has 19.25 total RVUs, consisting of 8.08 work RVUs, 9.52 practice expense RVUs (both facility and non-facility), and 1.65 malpractice RVUs.

What is the difference between CPT 23140 and 23146?

CPT 23140 covers excision of a bone cyst or benign tumor of the clavicle or scapula, while 23146 is used for removal of bone lesions with greater complexity or involving different anatomical considerations. The clinical documentation and pathology findings determine the appropriate code selection.

Does CPT 23146 require a modifier for laterality?

Yes, CPT 23146 requires a laterality modifier (RT for right or LT for left) to specify which shoulder was treated. Failure to include the appropriate modifier will result in claim denial by most payers.

Can CPT 23146 be billed with shoulder arthroscopy codes?

CPT 23146 can be billed with shoulder arthroscopy codes if the procedures are distinct and separately identifiable, but you must check NCCI edits and may need to append modifier 59 or XU to indicate a separate procedure. Documentation must clearly support both procedures as medically necessary.

What documentation is required to bill CPT 23146?

Required documentation includes pre-operative imaging confirming the bone lesion, a detailed operative report describing the surgical approach and lesion removal, laterality specification, pathology report, and medical necessity justification. The operative note must detail lesion size, margins, and any reconstruction performed.

Is CPT 23146 covered by Medicare for benign bone lesions?

Yes, Medicare covers CPT 23146 for both benign and malignant bone lesions when medically necessary. Documentation must support that the lesion causes symptoms, functional impairment, has malignant potential, or requires removal for diagnostic purposes. Pre-authorization may be required by some Medicare Advantage plans.