CPT 23184Surgery

Remove humerus lesion

CPT code 23184 covers the surgical removal of a lesion (abnormal tissue growth, tumor, or bone cyst) from the humerus, which is the upper arm bone. This is an open surgical procedure that involves making an incision to access and remove the abnormal tissue from the bone.

Showing rates for

National Average

Base Medicare rate

$734.27

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

9.9

PE RVU (NF)

10.8

MP RVU

Total RVU

22.7

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

NCCI bundling edits

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Billing tips

Document exact lesion size, location (proximal/mid/distal humerus), and depth in operative report
Impact: Prevents downcoding or denials; size and complexity documentation supports modifier 22 claims for potential 20-50% payment increase ($146.85-$367.14 additional)
Submit pathology report with claim showing tissue analysis confirming lesion removal
Impact: Reduces medical necessity denials by 60-70%; creates defensible audit trail for high-value surgical claims
Verify whether bone grafting was performed and bill separately (20900-20902) as it's not bundled with 23184
Impact: Captures additional $200-$600 in reimbursement for graft placement commonly performed during lesion removal
Use facility setting (ASC or hospital) rather than office to ensure appropriate reimbursement at $734.27; verify setting on claim form
Impact: Both facility and non-facility rates are identical at $734.27, but incorrect place of service coding causes processing delays
For Medicare patients, verify 90-day global period and avoid billing separately for routine post-operative visits
Impact: Prevents refund requests; 90-day global includes all related E/M services saving $150-$300 in potential recoupments
Code to highest specificity: if lesion requires extensive bone resection, verify that 23220 (radical resection) isn't more appropriate
Impact: Code 23220 reimburses at significantly higher rate; undercoding loses $400-$800 per case in legitimate reimbursement

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23184 in 2025?

The 2025 Medicare national average reimbursement for CPT 23184 is $734.27 for both facility and non-facility settings. This rate is calculated using 22.7 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary based on geographic locality adjustments.

How many RVUs is CPT code 23184 worth?

CPT 23184 has a total of 22.7 RVUs, consisting of 9.9 work RVUs, 10.8 practice expense RVUs (both facility and non-facility), and 2.0 malpractice RVUs. This makes it a moderately high-value surgical procedure in terms of relative value units.

What is the global period for CPT 23184?

CPT 23184 has a 90-day global surgical period. This means all routine pre-operative and post-operative care within 90 days of the procedure is included in the reimbursement and should not be billed separately. Only complications or unrelated services can be billed during this period with appropriate modifiers.

Can CPT 23184 be billed with a fracture repair code?

Billing 23184 with fracture repair codes requires careful documentation. If the lesion removal is incidental to fracture treatment at the same site, it's typically bundled. However, if the lesion is at a distinctly different location or the removal is unrelated to fracture management, modifier 59 may be appropriate with comprehensive documentation supporting separate procedures.

What's the difference between CPT 23184 and 23220?

CPT 23184 is for simple removal of a humeral lesion, typically benign, with limited bone resection. CPT 23220 describes radical resection of a bone tumor including a wide margin of normal tissue, often for malignant or aggressive lesions. Code 23220 involves more extensive surgery, carries higher reimbursement, and requires documentation of tumor characteristics justifying radical resection.

Do I need pre-authorization for CPT 23184?

Pre-authorization requirements vary by payer. Most commercial insurers require prior authorization for CPT 23184 as it's an outpatient surgical procedure. Medicare traditional plans typically don't require pre-auth, but Medicare Advantage plans often do. Always verify with the specific payer before scheduling to avoid denial. Submit imaging and clinical documentation supporting medical necessity with authorization requests.

Can CPT 23184 be performed bilaterally?

Yes, if lesions are present in both humeri and removed during the same operative session, append modifier 50 for bilateral procedure. Documentation must clearly indicate separate lesions in each arm with individual operative descriptions. Most payers reimburse bilateral procedures at 150% of the unilateral rate, though policies vary. Some payers require reporting each side separately with LT/RT modifiers instead of modifier 50.