CPT 23200Surgery

Resect clavicle tumor

CPT code 23200 covers the surgical removal of a tumor from the clavicle (collarbone). This is a major surgical procedure typically performed when imaging reveals a benign or malignant growth in the collarbone that requires excision.

Showing rates for

National Average

Base Medicare rate

$1,475.97

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

22.71

PE RVU (NF)

18.29

MP RVU

4.63

Total RVU

45.63

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

NCCI bundling edits

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Billing tips

Document tumor size in three dimensions, exact anatomic location on clavicle (medial, mid-shaft, lateral third), and relationship to neurovascular structures
Impact: Critical for supporting medical necessity and preventing denials; poor documentation can result in 100% claim denial ($1,475.97 loss)
Include pathology report with final claim submission or ensure it's available in medical record for audits
Impact: Lack of pathologic confirmation can trigger recoupment demands; some payers require malignant vs benign documentation for proper payment tier
When reconstruction is performed (plates, bone graft), bill separately with appropriate codes (20900-20902 for bone graft, 23515 for clavicle fixation) and modifier 51
Impact: Additional reimbursement of $500-$1,200 depending on reconstruction complexity; failure to bill separately leaves money on the table
For malignant tumors, verify prior authorization was obtained and diagnosis code clearly indicates malignancy (C40.01 for malignant neoplasm of scapula and long bones of upper limb)
Impact: Missing authorization can result in automatic denial; appeals process averages 45-90 days delaying $1,475.97 payment
Do not bundle incidental soft tissue tumor removal into 23200; if separate soft tissue mass excision is performed, bill 23075/23076 with modifier 59
Impact: Potential additional reimbursement of $400-$800 for separate soft tissue component when appropriately documented
Verify global period (090 days) and ensure related E/M services during global period use appropriate modifiers (24 for unrelated, 25 for separately identifiable same-day)

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23200 in 2025?

The 2025 Medicare national average payment for CPT 23200 is $1,475.97 for both facility and non-facility settings. This is based on 45.63 total RVUs multiplied by the 2025 conversion factor of $32.3465. Actual payment may vary by geographic locality.

Can CPT 23200 be billed with a bone graft code?

Yes, bone grafting codes (20900-20902) can be billed separately with CPT 23200 when reconstruction is required following tumor resection. Use modifier 51 on the secondary procedure and ensure the operative report clearly documents the bone graft as a distinct procedure beyond the tumor resection.

What diagnosis codes support medical necessity for CPT 23200?

Common supporting diagnosis codes include C40.01 (malignant neoplasm of clavicle), D16.01 (benign neoplasm of clavicle), M85.60 (other cyst of bone for aneurysmal bone cyst), and D48.0 (neoplasm of uncertain behavior of bone). The diagnosis must correlate with imaging and pathology findings.

Is CPT 23200 a facility-only code or can it be performed in an ASC?

CPT 23200 can be performed in hospital inpatient, hospital outpatient, or ambulatory surgery center settings. The 2025 Medicare payment is $1,475.97 in both facility and non-facility settings, indicating the physician work component is valued the same regardless of location.

How many RVUs is CPT code 23200 worth?

CPT 23200 has 45.63 total RVUs in 2025, consisting of 22.71 work RVUs, 18.29 practice expense RVUs (both facility and non-facility), and 4.63 malpractice RVUs. This makes it a high-value surgical procedure from an RVU perspective.

What is the global period for CPT 23200?

CPT 23200 has a 090-day global period, meaning all routine postoperative care for 90 days following surgery is included in the base reimbursement. E/M services during this period require modifier 24 (unrelated) or 25 (separately identifiable) to be reimbursed separately.

Do I need prior authorization for CPT 23200?

Most Medicare Advantage and commercial payers require prior authorization for CPT 23200 due to its high cost and surgical nature. Traditional Medicare typically does not require authorization but may conduct retrospective audits. Always verify specific payer requirements before scheduling the procedure to avoid denials.