CPT 23180Surgery

Remove collar bone lesion

CPT code 23180 covers the surgical removal of an abnormal growth or lesion from the clavicle (collar bone). This is an open surgical procedure where the surgeon cuts into the bone to remove the abnormal tissue.

Showing rates for

National Average

Base Medicare rate

$686.72

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

8.99

PE RVU (NF)

10.4

MP RVU

1.84

Total RVU

21.23

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

NCCI bundling edits

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Billing tips

Always append laterality modifier (RT or LT) to avoid automatic denial or claim suspension
Impact: Prevents 100% of preventable denials due to missing anatomical location; saves 7-14 days in claim processing time
Document lesion size, depth, and bone involvement in operative report to support modifier 22 claims when procedure complexity exceeds typical
Impact: Can increase reimbursement by $137-$343 (20-50% above base $686.72) for complex cases with proper documentation
Bill bone graft separately with appropriate CPT codes (20900-20902) when autograft or allograft is used to fill defect after lesion removal
Impact: Additional $200-$600 in reimbursement when bone grafting is medically necessary and documented as separate procedure
Verify frozen section pathology (88331) is billed separately by pathology department, not bundled with surgical code
Impact: Ensures pathology services are properly captured; typically $150-$250 in additional facility revenue
For malignant lesions, ensure oncologic diagnosis codes (C40.01 for malignant neoplasm of clavicle) are primary to support medical necessity
Impact: Reduces denial risk by 40-60% compared to using non-specific or benign diagnosis codes for potentially malignant lesions
When performed in ASC setting, confirm code is on approved ASC payable list and facility is billing ASC rate appropriately
Impact: ASC facility payment approximately $3,800-$4,200 when properly coded; significant revenue loss if miscoded as office procedure

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23180 in 2025?

The 2025 Medicare national average reimbursement for CPT 23180 is $686.72 for both facility and non-facility settings. This rate is based on 21.23 total RVUs multiplied by the 2025 conversion factor of 32.3465.

How many RVUs is CPT code 23180 worth?

CPT 23180 has 21.23 total RVUs in 2025, consisting of 8.99 work RVUs, 10.4 practice expense RVUs (both facility and non-facility), and 1.84 malpractice RVUs.

What is the difference between CPT 23180 and 23140?

CPT 23140 is for excision of a bone cyst or benign tumor of the clavicle without autograft, while CPT 23145 includes autograft and 23146 is for excision with allograft. CPT 23180 specifically describes removal of a clavicular lesion and is typically used for more straightforward excisions. The distinction depends on whether reconstruction with graft material is performed as part of the primary procedure.

Can CPT 23180 be billed bilaterally?

While anatomically possible, bilateral clavicle lesion excision during the same operative session is extremely rare. If performed bilaterally, append modifier 50 and provide clear documentation of medical necessity for simultaneous bilateral procedures. Most payers will reimburse at 150% of the unilateral rate when properly documented.

Does CPT 23180 have a global period?

Yes, CPT 23180 has a 90-day global surgical period. This means routine postoperative care for 90 days after the procedure is included in the reimbursement and cannot be billed separately. Any unrelated procedures during this period require modifier 79, and related returns to OR require modifier 78.

What diagnosis codes support medical necessity for CPT 23180?

Common supporting diagnosis codes include D16.01 (benign neoplasm of clavicle), C40.01 (malignant neoplasm of clavicle), M85.60 (other cyst of bone, unspecified site), and M85.50 (aneurysmal bone cyst). The diagnosis must support the need for surgical excision rather than observation or simple biopsy.

Can I bill bone graft separately with CPT 23180?

Yes, if bone grafting is performed to fill the defect after lesion excision and is not inherent to the primary procedure, you may bill CPT 20900 (bone graft, minor or small), 20902 (bone graft, major or large), or applicable allograft codes separately. Documentation must clearly indicate the graft was necessary and describe the source and volume of graft material used.