CPT 23170Surgery

Remove collar bone lesion

CPT code 23170 covers the surgical removal of abnormal growths or diseased tissue from the clavicle (collar bone). This procedure involves cutting into the bone to remove benign or malignant lesions while preserving as much healthy bone structure as possible.

Showing rates for

National Average

Base Medicare rate

$563.80

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

7.21

PE RVU (NF)

8.75

MP RVU

1.47

Total RVU

17.43

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

NCCI bundling edits

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Billing tips

Always append laterality modifiers (RT/LT) as Medicare and most commercial payers require these for anatomic specificity on paired structures
Impact: Prevents automatic denial and claim rejection; 15-20% of claims without laterality modifiers are returned unprocessed
Document lesion size, depth, and bone involvement with preoperative imaging correlation in operative note to support medical necessity and differentiate from simpler soft tissue excision codes
Impact: Reduces denial rate by 30-40% and supports coding accuracy versus downcoding to lower-valued soft tissue excision codes ($200-300 difference)
Bill bone graft procedures separately (20900-20902 series) when performed, as these are not bundled with lesion excision and add $150-400 in additional reimbursement
Impact: Captures additional $150-400 per case; failure to separately code leaves significant revenue on table
Submit pathology report with initial claim for malignant or uncertain lesions to establish medical necessity and prevent requests for additional documentation
Impact: Reduces processing time by 7-10 days and decreases denial rate by approximately 25% for expedited payment
Use modifier 22 with detailed operative note when lesion exceeds 3cm or requires reconstruction; include specific time and complexity documentation
Impact: Can increase reimbursement by $110-280 (20-50%) when properly documented and approved
Verify global period (90 days) before billing any related follow-up procedures and use appropriate modifiers (58, 78, 79) to avoid bundling denials
Ensures separate payment for legitimate additional procedures; prevents automatic denials of $400-600 in related work

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23170 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 23170 is $563.80 for both facility and non-facility settings. This rate is based on a total RVU of 17.43 multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on GPCI adjustments.

What RVU value is assigned to CPT code 23170?

CPT 23170 has a total RVU of 17.43, consisting of work RVU of 7.21, practice expense RVU of 8.75 (both facility and non-facility), and malpractice RVU of 1.47. The high work RVU reflects the complexity and intensity of surgically removing a clavicle lesion.

Does CPT 23170 require a modifier for left or right side?

Yes, CPT 23170 requires laterality modifiers RT (right) or LT (left) as the clavicle is a paired anatomic structure. Medicare and most commercial payers mandate these modifiers for proper claim processing, and claims submitted without laterality may be rejected or denied.

Can CPT 23170 be billed bilaterally with modifier 50?

Yes, CPT 23170 can be billed with modifier 50 if lesions are excised from both clavicles during the same operative session. This would reimburse at 150% of the standard rate ($845.70 for Medicare), though bilateral clavicle lesion excision is clinically rare.

What is the global period for CPT 23170?

CPT 23170 has a 90-day global surgical period. All routine postoperative care within 90 days of the procedure is included in the reimbursement. Any additional related procedures during this period require appropriate modifiers (58, 78, or 79) to receive separate payment.

What diagnosis codes are commonly used with CPT 23170?

Common ICD-10 codes paired with CPT 23170 include D16.01 (benign neoplasm of scapula and long bones of upper limb), C40.01 (malignant neoplasm of scapula and long bones of upper limb), M85.40-M85.49 (solitary bone cyst), and D48.0 (neoplasm of uncertain behavior of bone). The specific diagnosis must support medical necessity for surgical excision.

How does CPT 23170 differ from soft tissue excision codes?

CPT 23170 specifically describes excision of a lesion within the bone (clavicle) requiring bone exposure and bone tissue removal, while soft tissue excision codes (21555-21556) describe removal of masses in muscle, fascia, or subcutaneous tissue without bone involvement. Documentation must clearly demonstrate intraosseous pathology and bone resection to support CPT 23170.