CPT 23552Surgery

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CPT 23552 covers surgical removal of the end portion of the collarbone (distal clavicle) along with placement of a graft, typically performed to treat chronic shoulder separation or arthritis at the AC joint.

Showing rates for

National Average

Base Medicare rate

$641.75

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

8.82

PE RVU (NF)

9.38

MP RVU

1.64

Total RVU

19.84

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

NCCI bundling edits

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Billing tips

Document the graft type, source, and technique explicitly in operative report - specify autograft vs allograft, anatomic fixation points, and reconstruction method
Impact: Failure to document graft component may result in downcoding to CPT 23120 (simple distal clavicle resection), reducing reimbursement by approximately $430 per case
Clearly document chronicity in both pre-operative notes and operative report - include duration of symptoms, failed conservative treatments, and imaging showing chronic changes
Impact: Acute vs chronic distinction affects code selection; inadequate documentation of chronic/acquired nature risks denial or medical necessity challenges
Bill in ASC setting when medically appropriate rather than hospital outpatient - both have same Medicare rate but facility fees differ
Impact: Identical physician reimbursement ($641.75) but ASC typically has lower patient cost-sharing, improving collections
Bundle hardware costs (suture anchors, buttons, screws) into procedure when billed in facility setting - do not separately bill implants
Impact: Separate billing of surgical implants will result in denial; implants are included in facility fee, not physician reimbursement
For workers' compensation cases, verify state fee schedule as many states reimburse 150-200% of Medicare rates for this code
Impact: Workers' comp reimbursement may range from $962.63 to $1,283.50 in high-reimbursing states versus $641.75 Medicare rate
When performed with rotator cuff repair or other shoulder procedures, verify NCCI edits and use modifier 59 appropriately for distinct anatomic sites

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23552 in 2025?

The 2025 Medicare national average reimbursement for CPT 23552 is $641.75 for both facility and non-facility settings. This is based on a total RVU of 19.84 multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement may vary by geographic locality based on GPCI adjustments.

What is the difference between CPT 23552 and 23120?

CPT 23552 includes both distal clavicle resection AND coracoclavicular ligament reconstruction with graft, while CPT 23120 is simple distal clavicle excision without ligament reconstruction. The graft component in 23552 addresses chronic AC separation or instability requiring stabilization, resulting in significantly higher reimbursement and work RVUs (8.82 vs approximately 5.0 for 23120).

How many RVUs is CPT code 23552 worth?

CPT 23552 has a total RVU value of 19.84, consisting of 8.82 work RVUs, 9.38 practice expense RVUs (both facility and non-facility), and 1.64 malpractice RVUs. This makes it a high-value orthopedic procedure reflecting the complexity of open shoulder reconstruction with grafting.

Can CPT 23552 be billed with arthroscopic rotator cuff repair?

Yes, but proper documentation and modifiers are essential. If the distal clavicle resection with graft and rotator cuff repair address distinct pathology through separate approaches, modifier 59 should be appended to 23552. Verify NCCI edits and ensure operative notes clearly document medical necessity for both procedures and that they are not components of a single comprehensive service.

What documentation is required to bill CPT 23552?

Required documentation includes: operative note detailing distal clavicle resection extent, specific graft type and source, coracoclavicular ligament reconstruction technique, fixation method; pre-operative notes documenting chronicity and failed conservative treatment (3-6 months minimum); imaging reports showing chronic AC pathology; and post-operative care plan. The graft reconstruction component must be explicitly documented to avoid downcoding.

Is CPT 23552 an inpatient or outpatient procedure?

CPT 23552 is typically performed as an outpatient procedure in either hospital outpatient surgery department or ambulatory surgery center (ASC). It is not on CMS's inpatient-only list. The 2025 Medicare reimbursement is identical for both facility and non-facility settings at $641.75, though patient cost-sharing and total facility fees may differ.

What modifiers are commonly used with CPT 23552?

The most commonly used modifiers include: LT/RT (laterality - required on every claim), modifier 22 (increased procedural services for unusual complexity), modifier 50 (bilateral procedure if both shoulders done), modifier 51 (multiple procedures when secondary), modifier 59 (distinct procedural service to prevent bundling), and modifier 78 (return to OR during postoperative period). Laterality modifiers are mandatory.