CPT 23150Surgery

Removal of humerus lesion

CPT code 23150 covers the surgical removal of a lesion (abnormal growth or tumor) from the humerus, which is the upper arm bone between the shoulder and elbow.

Showing rates for

National Average

Base Medicare rate

$664.07

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

8.91

PE RVU (NF)

9.82

MP RVU

1.8

Total RVU

20.53

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Always append laterality modifier (LT or RT) to CPT 23150 as Medicare and most commercial payers require anatomic specificity for extremity procedures
Impact: Prevents automatic denial or claim rejection; missing laterality results in 100% payment delay or denial
Document lesion size, location on humerus (proximal, mid-shaft, distal), and depth in operative report to support medical necessity and potential modifier 22 for unusually complex cases
Impact: Supports full $664.07 reimbursement and provides justification for additional 20-30% payment with modifier 22 when appropriate
When bone grafting is performed to fill the defect after lesion removal, bill separately with CPT 20900 (minor autograft) or 20902 (major autograft) as these are not bundled with 23150
Impact: Captures additional $150-400 in reimbursement depending on graft source and complexity
Verify whether procedure is performed in facility or non-facility setting; while both rates are identical at $664.07 for 23150, billing location (POS code) must match actual site of service
Impact: Incorrect place of service coding triggers recoupment audits and potential false claims liability
Link appropriate ICD-10 diagnosis codes documenting lesion type (D16.01 for benign neoplasm, M85.5 for aneurysmal bone cyst, etc.) to establish medical necessity and differentiate from trauma codes
Impact: Prevents denials for lack of medical necessity; specific pathology coding supports coverage determination
For lesions requiring frozen section pathology during surgery, bill 88331 separately as intraoperative consultation; this is not included in the surgical global package

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 23150?

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 23150 in 2025?

The 2025 Medicare national average reimbursement for CPT 23150 is $664.07 for both facility and non-facility settings. This rate is based on 20.53 total RVUs multiplied by the 2025 conversion factor of $32.3465. Actual payment may vary by geographic locality based on the GPCI adjustment factors for your region.

Can CPT 23150 be billed with a bone graft code?

Yes, bone grafting codes (20900 for minor autograft or 20902 for major autograft) can be billed separately with CPT 23150 when bone grafting is performed to fill the defect created by lesion removal. These codes are not bundled per CCI edits, but documentation must clearly show the graft harvest and placement as distinct procedures. Some payers may require modifier 59 or XS to indicate separate services.

What modifiers are required when billing CPT code 23150?

Laterality modifiers LT (left) or RT (right) are required when billing CPT 23150 to specify which arm was treated. Additional modifiers may include 50 for bilateral procedures (rare), 22 for increased complexity, 78 for related return to OR, or 79 for unrelated procedures during the global period. Failure to include laterality modifiers will result in claim denial or rejection.

How many RVUs is CPT 23150 worth in 2025?

CPT 23150 has 20.53 total RVUs in 2025, consisting of 8.91 work RVUs, 9.82 practice expense RVUs (both facility and non-facility), and 1.8 malpractice RVUs. This relatively high RVU value reflects the moderate surgical complexity and risk associated with bone tumor excision procedures.

What is the difference between CPT 23150 and 23155?

CPT 23150 is for removal of a humerus lesion (typically benign tumors or cysts requiring curettage), while CPT 23155 describes resection of the humeral head, which is a more extensive procedure involving removal of the proximal humerus including the ball-and-socket joint component. Code selection depends on the extent of bone removed and whether joint reconstruction is required. CPT 23155 carries significantly higher RVUs and reimbursement.

What diagnosis codes support medical necessity for CPT 23150?

Common supporting ICD-10 codes include D16.01 (benign neoplasm of scapula and long bones of upper limb), M85.50 (aneurysmal bone cyst, unspecified site), M85.60 (other cyst of bone), C40.01 (malignant neoplasm of scapula and long bones of upper limb when appropriate), and M84.421 (pathological fracture, right humerus). The diagnosis must document a lesion requiring surgical intervention rather than observation.

Is CPT 23150 covered in an ASC or only hospital outpatient?

CPT 23150 is typically covered in both Ambulatory Surgery Centers (ASC) and hospital outpatient settings. The 2025 Medicare facility rate is $664.07 in both settings for physician payment, though the ASC facility fee differs from hospital outpatient facility payment. Coverage depends on patient complexity, anesthesia requirements, and payer-specific policies. Some complex cases may require hospital inpatient admission based on medical necessity.