CPT 23182Surgery

Remove shoulder blade lesion

CPT code 23182 covers the surgical removal of an abnormal growth or lesion from the shoulder blade (scapula). This procedure involves making an incision to access and excise the lesion, which may be a benign tumor, cyst, or other abnormal tissue growth.

Showing rates for

National Average

Base Medicare rate

$669.90

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

8.61

PE RVU (NF)

10.33

MP RVU

1.77

Total RVU

20.71

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

NCCI bundling edits

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Billing tips

Document lesion size, exact anatomical location on scapula, and depth of excision in operative report
Impact: Proper documentation prevents denials and supports medical necessity; missing size documentation causes 15-25% of initial denials
Always append laterality modifiers (LT/RT) as Medicare and most commercial payers require these for anatomically paired structures
Impact: Failure to include laterality results in automatic claim rejection requiring resubmission, delaying payment by 30-45 days
Consider modifier 22 for lesions >5cm, those requiring extensive dissection through rotator cuff muscles, or those with neurovascular involvement
Impact: Successfully appealed modifier 22 claims can increase reimbursement by $134-$201 (20-30% increase) but require detailed operative time and complexity documentation
Submit pathology report with initial claim when billing for tumor excision to establish medical necessity
Impact: Proactive pathology submission reduces payer requests for additional documentation by 60% and accelerates claim processing
Verify that bone grafting (20900-20902) or soft tissue reconstruction (14000 series) are not bundled by checking NCCI edits before billing separately
Impact: Unbundling violations can result in recoupment of $200-$800 depending on additional codes billed; use modifier 59 only when truly distinct
Code to the highest specificity: distinguish 23182 from partial scapulectomy (23190) or total scapulectomy (23172) based on extent of bone removal
Impact: Upcoding to 23190 (partial scapulectomy, $1,200+ payment) without documentation of segmental bone removal constitutes fraud; downcoding from appropriate 23190 loses $530+ per case

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Frequently asked questions

What is the CPT code 23182 reimbursement rate for 2025?

The 2025 Medicare national average reimbursement for CPT 23182 is $669.90 for both facility and non-facility settings. This rate is based on 20.71 total RVUs (8.61 work RVU, 10.33 practice expense RVU, and 1.77 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465. Commercial payer rates typically range from 120-250% of Medicare rates depending on contract negotiations.

What does CPT code 23182 include?

CPT 23182 includes the surgical excision of a lesion or tumor from the scapula (shoulder blade), including the incision, dissection through soft tissue, removal of the lesion with appropriate margins, and standard closure. It does not include extensive bone reconstruction, bone grafting, complex soft tissue reconstruction, or complete or partial scapulectomy, which have separate codes.

How do I bill CPT 23182 with modifier 22?

Modifier 22 should be appended to 23182 when the procedure requires significantly greater work than typical due to lesion size (>5cm), difficult anatomical location requiring extensive muscle dissection, neurovascular involvement, or unusual patient factors. Submit a detailed cover letter specifying the additional complexity, operative report documenting increased time and effort, and comparison to typical procedure parameters. Additional reimbursement typically ranges from 20-30% ($134-$201) when approved.

What is the difference between CPT 23182 and 23190?

CPT 23182 is for excision of a lesion from the scapula where the bone structure remains largely intact, while CPT 23190 describes partial scapulectomy involving removal of a segment of the scapular bone. The key distinction is the extent of bone removal: 23182 removes the lesion with minimal bone loss, whereas 23190 involves resection of a portion of the scapula requiring potential reconstruction. CPT 23190 has significantly higher reimbursement due to increased complexity.

Can CPT 23182 be billed bilaterally?

Yes, CPT 23182 can be billed bilaterally using modifier 50 if lesions are excised from both scapulae during the same operative session. Medicare typically reimburses bilateral procedures at 150% of the unilateral rate ($1,004.85), though this must be medically justified. Alternatively, some payers prefer reporting with LT and RT modifiers on separate lines. Always verify payer-specific bilateral surgery policies.

What diagnosis codes support medical necessity for CPT 23182?

Common supporting ICD-10 codes include D16.0 (benign neoplasm of scapula), C40.01/C40.02 (malignant neoplasm of scapula), D48.0 (neoplasm of uncertain behavior of bone), M85.40-M85.49 (solitary bone cyst), and M85.60-M85.69 (other bone cyst). The diagnosis must document a specific lesion requiring surgical excision, supported by imaging and clinical findings. Generic pain codes without documented lesion presence may result in denial.

What are the documentation requirements for CPT 23182?

Required documentation includes pre-operative diagnosis, exact lesion location on the scapula, three-dimensional lesion measurements, operative approach and incision details, depth of dissection with structures encountered, method of excision and margin status, specimen handling (pathology submission), closure technique, laterality designation, and total operative time. Missing lesion size or anatomical location specifics are the most common documentation deficiencies leading to denials or downcoding.