CPT 23485Surgery

Revision of collar bone

CPT 23485 covers surgical revision of the clavicle (collar bone), typically performed to correct complications from a previous clavicle surgery, such as nonunion, malunion, or hardware issues. This is a secondary procedure to repair or improve outcomes from an initial collar bone surgery.

Showing rates for

National Average

Base Medicare rate

$939.67

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

13.91

PE RVU (NF)

12.36

MP RVU

2.78

Total RVU

29.05

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

NCCI bundling edits

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Billing tips

Document the specific indication for revision (nonunion, malunion, hardware failure, infection) with radiographic evidence and dates of prior surgeries
Impact: Reduces denial rate by 60-75%; missing documentation of failed prior treatment is the #1 denial reason
Bill facility fee separately when performed in hospital setting; facility and non-facility rates are identical at $939.67, but facility overhead should be captured
Impact: Ensures proper facility reimbursement separate from professional component
For complex revisions requiring bone graft, verify whether autograft harvest is separately billable (20900-20902) based on payer policy
Impact: Can add $150-400 in additional reimbursement when separately billable and properly documented
Use modifier 22 with detailed operative note when revision involves extensive scar tissue dissection, multiple hardware removals, or bone grafting beyond typical
Impact: Can increase reimbursement $188-470 (20-50% increase) with proper documentation
Ensure time elapsed from initial surgery is documented; most payers require minimum 90-day interval for revision to be considered separate procedure
Impact: Prevents bundling denials and global period payment reductions
For Medicare patients, verify LCD/NCD policies for revision orthopedic procedures and ensure all coverage criteria are met before scheduling
Impact: Prevents medical necessity denials which affect 100% of reimbursement ($939.67 loss per case)

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23485 in 2025?

The 2025 Medicare national average reimbursement for CPT 23485 is $939.67 for both facility and non-facility settings, based on 29.05 total RVUs and a conversion factor of 32.3465.

How long after initial clavicle surgery can you bill CPT 23485?

While there is no absolute timeframe in CPT coding, most payers require documentation that the revision is performed outside the global period of the initial surgery (typically 90 days) or that it represents a planned staged procedure or complication requiring modifier 58 or 78.

Can CPT 23485 be billed with hardware removal code 20680?

Generally no, hardware removal is considered integral to the revision procedure and bundled into CPT 23485. However, if extensive hardware removal is performed as a distinct separate procedure, modifier 59 may be appropriate with comprehensive documentation.

What documentation is required to support medical necessity for CPT 23485?

Required documentation includes radiographic evidence of nonunion/malunion, clinical documentation of failed conservative treatment, operative report from initial surgery, physical exam findings, and detailed current operative report explaining why revision is medically necessary.

What are the total RVUs for CPT 23485 in 2025?

CPT 23485 has 29.05 total RVUs in 2025, comprised of 13.91 work RVUs, 12.36 practice expense RVUs, and 2.78 malpractice RVUs.

Which medical specialties typically bill CPT 23485?

CPT 23485 is primarily billed by orthopedic surgeons, trauma surgeons, and sports medicine surgeons performing complex revision procedures on the clavicle in hospital or ASC settings.

When should modifier 22 be used with CPT 23485?

Modifier 22 should be appended to CPT 23485 when the revision surgery involves significantly greater complexity than typical, such as extensive scar tissue dissection, multiple hardware removals, complex bone grafting, or prolonged operative time, with detailed documentation supporting the additional work.