CPT 23532Surgery

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CPT 23532 covers open surgical repair of a broken collarbone (clavicle) that hasn't healed properly or was an old injury, using a bone graft to help it heal. This is a more complex procedure than simple fracture repair because it involves correcting a non-healing or poorly healed fracture.

Showing rates for

National Average

Base Medicare rate

$625.26

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

8.2

PE RVU (NF)

9.44

MP RVU

1.69

Total RVU

19.33

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

NCCI bundling edits

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Billing tips

Document time elapsed since original injury and failed conservative treatment attempts with specific dates and imaging findings showing non-union or malunion
Impact: Critical for medical necessity; absence causes denials averaging 100% payment loss ($625.26)
Clearly specify graft type (autograft vs allograft), harvest site if autograft, and volume/dimensions of graft material in operative report
Impact: Justifies use of 23532 over 23515; prevents $150-200 downcoding to non-graft procedure
Bill bone graft harvesting separately with 20900 or 20902 when autograft obtained from separate incision site (iliac crest, distal radius)
Impact: Additional $150-400 reimbursement when properly documented and not bundled
Use modifier 22 with supporting documentation when case involves extensive hardware removal from prior surgery, significant bone loss, or infection debridement
Impact: Potential 20-30% payment increase ($125-188 additional) with detailed documentation
Verify Medicare LCD and payer-specific policies for non-union timeframe definitions (typically 3-6 months minimum from injury)
Impact: Prevents denials for premature surgical intervention; policies vary by MAC
Append appropriate laterality modifier (LT/RT) on initial claim submission to avoid automatic rejection and resubmission delays
Impact: Prevents 15-30 day payment delays from modifier-related rejections

Applicable modifiers

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 23532 in 2025?

The 2025 Medicare national average reimbursement for CPT 23532 is $625.26 for both facility and non-facility settings. This rate is based on 19.33 total RVUs (8.2 work RVU, 9.44 PE RVU, 1.69 MP RVU) multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary based on geographic location and MAC adjustments.

What is the difference between CPT 23515 and 23532?

CPT 23515 is open treatment of a clavicular fracture without bone grafting, while 23532 specifically requires bone graft placement for chronic fractures or non-unions. Code 23532 has higher RVUs (19.33 vs approximately 13-14 for 23515) and reimburses approximately $150-200 more. The graft component and chronic/non-union nature must be clearly documented to justify 23532.

How long must a clavicle fracture be present before it's considered chronic for CPT 23532?

Most Medicare contractors and payers require minimum 12 weeks (3 months) from injury with radiographic evidence of non-union or delayed union before considering surgical intervention with grafting medically necessary. Some policies specify 6 months for definitive non-union diagnosis. Documentation must show failed conservative treatment during this period.

Can I bill separately for bone graft harvesting with CPT 23532?

Yes, when autograft is harvested from a separate incision site (such as iliac crest), you can bill 20900 (minor graft) or 20902 (major graft) in addition to 23532. The harvest site must be documented as anatomically separate from the clavicle surgical site. Local or morselized graft from the immediate surgical field is included in 23532 and not separately billable.

What modifiers are required when billing CPT 23532?

Laterality modifiers LT (left) or RT (right) are required for every 23532 claim to specify which clavicle was treated. Additional modifiers may include 22 (increased complexity), 78 (return to OR), 59 (distinct service), or AS (assistant surgeon) depending on case circumstances. Missing laterality modifiers commonly cause claim rejections.

What documentation is needed to avoid denials for CPT 23532?

Essential documentation includes: original injury date with time elapsed, serial imaging showing non-union progression, detailed records of failed conservative treatment (minimum 3 months), operative report specifying graft type/source/volume, internal fixation details, and intraoperative findings confirming chronic fracture characteristics. Pre-authorization is recommended as many payers require prior approval for this procedure.

What are the most common denial reasons for CPT 23532?

The most frequent denials are: (1) insufficient documentation of non-union status vs acute fracture, (2) inadequate conservative treatment attempts before surgery, (3) downcoding to 23515 due to poor graft documentation, and (4) bundling denials when bone graft harvesting is billed separately. Medical necessity is the primary audit focus, requiring clear evidence that grafting was essential for fracture healing.