CPT 23210Surgery

Resect scapula tumor

CPT code 23210 covers the surgical removal of a tumor from the scapula (shoulder blade). This procedure involves cutting out the tumor along with some surrounding tissue to ensure complete removal.

Showing rates for

National Average

Base Medicare rate

$1,729.24

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

27.21

PE RVU (NF)

20.67

MP RVU

5.58

Total RVU

53.46

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

NCCI bundling edits

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Billing tips

Document tumor dimensions in three planes (length, width, depth) and margin status in centimeters before and after resection
Impact: Supports medical necessity and may justify modifier 22 for unusually large tumors (>5cm), potentially increasing reimbursement by $345-$865
Separately bill bone graft procedures (20900-20902) or soft tissue reconstruction (15734-15738) when performed, as these are not bundled with 23210
Impact: Can add $500-$2000 in additional reimbursement when reconstruction is required and properly documented as distinct procedures
Ensure pathology report is available and references the specimen as scapular tumor tissue; link to appropriate ICD-10 diagnosis codes (C40.01, D16.01, D48.0)
Impact: Prevents medical necessity denials; malignant diagnoses (C40.01) typically have higher approval rates than benign (D16.01)
Code intraoperative imaging separately (77002 for fluoroscopy) when used to verify tumor margins or guide resection
Impact: Adds approximately $75-$150 per claim when imaging guidance is documented as medically necessary
Verify global period (90 days) and avoid billing evaluation services during this period unless modifier 24 or 25 is appropriately applied
Impact: Prevents automatic denials of related E/M services; improper use can trigger audit flags and recoupment of $100-$300 per visit
For facility billing, ensure appropriate ICD-10-PCS codes are used (0PTN0ZZ for excision of scapula) in addition to CPT coding for professional fees
Impact: Ensures both professional ($1729.24) and facility payments are maximized; coding discrepancies can delay payment by 30-60 days

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23210 in 2025?

The 2025 Medicare national average reimbursement for CPT 23210 is $1729.24 for both facility and non-facility settings. This is based on 53.46 total RVUs (27.21 work RVU + 20.67 PE RVU + 5.58 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

How many RVUs is CPT code 23210 worth?

CPT 23210 has a total of 53.46 RVUs in 2025, consisting of 27.21 work RVUs, 20.67 practice expense RVUs, and 5.58 malpractice RVUs. This makes it a high-value orthopedic procedure reflecting the complexity of scapular tumor resection.

What is the difference between CPT 23210 and 23140?

CPT 23210 is for resection of a scapular tumor (benign or malignant bone neoplasm), while CPT 23140 is for excision or curettage of a bone cyst or benign tumor of the clavicle or scapula. Code 23210 is used for more extensive resections involving actual tumor removal with margins, whereas 23140 applies to simpler excisions or curettage of benign lesions without the complexity of oncologic resection.

Can CPT 23210 be billed bilaterally?

While technically possible using modifier 50, bilateral scapular tumor resection is extremely rare. Each side would require a separate pathologically confirmed tumor requiring resection. When appropriate, modifier 50 would increase total reimbursement to 150% of the base rate ($2593.86), but extensive documentation would be required to justify bilateral presentation.

What diagnosis codes support medical necessity for CPT 23210?

Primary diagnosis codes include C40.01 (malignant neoplasm of scapula), D16.01 (benign neoplasm of scapula), D48.0 (neoplasm of uncertain behavior of bone), and C79.51 (secondary malignant neoplasm of bone). The specific diagnosis must be confirmed by biopsy or imaging and documented in the operative report and pathology findings.

Is CPT 23210 subject to a global period?

Yes, CPT 23210 has a 90-day global period. This means routine postoperative care for 90 days following surgery is included in the $1729.24 reimbursement. Separate E/M services during this period require modifier 24 (unrelated) or 25 (significant, separately identifiable service) with appropriate documentation to receive additional payment.

What modifiers are most commonly used with CPT 23210?

The most common modifiers are RT/LT (laterality, required), modifier 22 (increased procedural services for unusually large or complex tumors), modifier 59 (distinct procedural service when billed with other shoulder procedures), and modifier 51 (multiple procedures). Modifier 22 requires detailed documentation of additional complexity to justify increased reimbursement beyond the base $1729.24 rate.