CPT 23490Surgery

Reinforce clavicle

CPT code 23490 covers a surgical procedure to reinforce the clavicle (collarbone), typically using internal fixation devices, bone grafts, or other structural support to strengthen a weakened or fractured collarbone.

Showing rates for

National Average

Base Medicare rate

$851.04

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

12.16

PE RVU (NF)

11.68

MP RVU

2.47

Total RVU

26.31

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

NCCI bundling edits

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Billing tips

Document medical necessity clearly, including failed conservative treatment, non-union duration (typically >6 months), and functional impairment
Impact: Prevents medical necessity denials which account for approximately 35% of rejections for this code
Specify hardware used (plates, screws, bone graft type) and whether autograft or allograft in operative report; bone graft harvesting may warrant separate code 20900-20902
Impact: Autograft harvesting can add $200-400 in additional reimbursement when properly documented and coded separately
Verify global period (90 days) and ensure all related visits within global period are not billed separately unless modifier 24 applies for unrelated E/M
Impact: Prevents $100-200 in denials from inappropriately billed postoperative visits
For pathological fractures, link diagnosis code to underlying condition (neoplasm, osteoporosis) and sequence appropriately with fracture code
Impact: Proper diagnosis sequencing reduces LCD denials by 40% and supports medical necessity
Submit modifier 22 claims with operative report and cover letter quantifying increased time, complexity, and anatomical difficulty with specific metrics
Impact: Properly documented modifier 22 claims can yield additional $170-425 but have 60% denial rate without compelling documentation
Verify ASC versus hospital outpatient status; same facility rate applies but facility policies and patient financial responsibility differ
Impact: Setting verification prevents patient surprise billing and ensures correct claim routing

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Frequently asked questions

What is the difference between CPT 23490 clavicle reinforcement and 23515 clavicle fracture repair?

CPT 23490 is specifically for reinforcement of the clavicle to strengthen weakened bone, typically for non-union, pathological fractures, or prophylactic stabilization. CPT 23515 is for acute fracture treatment with fixation. The key distinction is timing and indication: 23490 is for strengthening an existing structural problem, while 23515 treats acute traumatic fractures. Using 23490 for acute fracture repair is incorrect and may trigger denials.

How much does Medicare pay for CPT code 23490 in 2025?

The 2025 Medicare national average reimbursement for CPT 23490 is $851.04 for both facility and non-facility settings. This is based on 26.31 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic location based on locality-specific adjustments and individual payer contracts.

Can CPT 23490 be billed with bone graft harvesting codes?

Yes, bone graft harvesting (CPT 20900-20902) may be separately billable when autograft is obtained from a separate surgical site and used in the clavicle reinforcement. Append modifier 59 to the bone graft code to indicate it is a distinct procedural service. Documentation must clearly show the separate harvest site and medical necessity. Allograft material is typically included in the facility charge and not separately billable by the surgeon.

What diagnosis codes support medical necessity for CPT 23490?

Common supporting diagnosis codes include M84.41xK/P (pathological fracture of clavicle with nonunion or malunion), S42.0xxK/P (clavicle fracture with nonunion or malunion), C79.51 (secondary malignant neoplasm of bone), and M80.08xA (osteoporosis with pathological fracture of clavicle). The diagnosis must demonstrate structural weakness requiring reinforcement beyond standard fracture fixation.

Is CPT 23490 subject to a global surgical period?

Yes, CPT 23490 carries a 90-day global surgical period. All routine postoperative care within 90 days of surgery is included in the $851.04 payment and cannot be billed separately. Only unrelated E/M services (with modifier 24) or complications requiring return to OR (with modifier 78 or 79) may be billed during the global period.

When should modifier 22 be used with CPT 23490?

Modifier 22 is appropriate when clavicle reinforcement involves substantially greater complexity than typical cases, such as extensive bone loss requiring complex grafting, significant anatomical distortion from previous surgeries, or concurrent soft tissue reconstruction. Documentation must specify increased operative time (typically 50%+ beyond usual), anatomical challenges encountered, and additional effort required. Include comparison to typical case in your modifier 22 justification letter.

Can CPT 23490 be performed in an ASC or must it be hospital-based?

CPT 23490 can be performed in either an Ambulatory Surgery Center (ASC) or hospital outpatient/inpatient setting. The 2025 Medicare facility rate is $851.04 regardless of setting for physician payment. However, verify individual payer policies as some may require hospital setting for complex orthopedic procedures. Patient medical complexity, comorbidities, and anticipated post-operative needs often determine appropriate surgical venue.