CPT 23174Surgery

Remove humerus lesion

CPT code 23174 is used when a surgeon removes an abnormal growth or lesion from the humerus (the long bone in your upper arm between the shoulder and elbow). This is a surgical procedure that involves opening the area and excising the lesion from the bone.

Showing rates for

National Average

Base Medicare rate

$760.47

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

10.05

PE RVU (NF)

11.4

MP RVU

2.06

Total RVU

23.51

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

NCCI bundling edits

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Billing tips

Always append laterality modifiers (LT/RT) as first-line edit; missing laterality is the most common cause of claims rejection
Impact: Prevents immediate denial and resubmission delays that can extend payment cycle by 30-45 days
Document lesion size, depth, and histology in operative note; if lesion exceeds 5cm or requires extensive bone reconstruction, consider modifier 22
Impact: Modifier 22 can increase reimbursement by $150-$380 when properly documented and appealed with supporting documentation
Verify pre-authorization requirements; many commercial payers require prior auth for bone tumor excisions even when Medicare does not
Impact: Prevents denials that result in zero payment; pre-auth denials are difficult to overturn retrospectively
Do not bundle bone grafting with 23174 if autograft or allograft is used to fill defect; bill separately with +20900-20902 series
Impact: Additional reimbursement of $200-$600 depending on graft source and complexity; commonly undercoded
Bill facility and non-facility rates correctly based on place of service; both are $760.47 for this code, but verify actual POS code matches claim
Impact: Incorrect POS codes trigger audits and can result in recoupment demands even when payment amount is identical
For pathology specimens, ensure surgeon documents specimen was sent for pathologic evaluation; link to appropriate path codes (88304-88309)
Impact: Pathology services add $50-$350 in ancillary revenue and support medical necessity for the procedure

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23174 in 2025?

The 2025 Medicare national average reimbursement for CPT 23174 is $760.47 for both facility and non-facility settings. This is based on 23.51 total RVUs multiplied by the 2025 conversion factor of 32.3465. Local Medicare rates may vary by MAC jurisdiction.

What RVUs does CPT code 23174 carry?

CPT 23174 carries 10.05 work RVUs, 11.4 practice expense RVUs (both facility and non-facility), and 2.06 malpractice RVUs, for a total of 23.51 RVUs. These values are from the CMS 2025 Medicare Physician Fee Schedule released December 23, 2024.

Does CPT 23174 require a modifier for left or right side?

Yes, CPT 23174 requires a laterality modifier (LT for left or RT for right) for Medicare and most commercial payers. Claims submitted without the appropriate laterality modifier will typically be rejected or denied. Always append the correct modifier based on which humerus was treated.

What is the difference between CPT 23174 and 23140?

CPT 23140 describes excision or curettage of a bone cyst or benign tumor of the proximal humerus, while 23174 describes removal of a lesion (benign or malignant) from any location on the humerus. Code 23174 is typically used for more extensive excisions or when lesion location is not limited to the proximal humerus. Review operative documentation carefully to select the appropriate code.

Can I bill bone grafting separately with CPT 23174?

Yes, bone grafting is not bundled with CPT 23174. If autograft, allograft, or bone graft substitute is used to fill the defect after lesion removal, report the appropriate bone graft code (20900-20902 series) separately. Documentation must clearly describe the graft source, preparation, and placement.

What diagnoses support medical necessity for CPT 23174?

Common supporting diagnoses include benign bone neoplasms (D16.01), malignant bone neoplasms (C40.01), bone cysts (M85.51-M85.52), fibrous dysplasia (M85.01), osteochondroma (D16.01), and pathologic fractures related to bone lesions. Pre-operative imaging and clinical documentation of symptoms (pain, fracture risk, functional limitation) are essential to establish medical necessity.

Is prior authorization required for CPT 23174?

Medicare does not typically require prior authorization for CPT 23174, but many commercial payers and Medicare Advantage plans do require pre-authorization for orthopedic oncology procedures. Always verify authorization requirements with the specific payer before scheduling surgery to avoid denial. Some payers may require peer-to-peer review for bone tumor excisions.