CPT 23900Surgery

Interthoracoscplr amputation

CPT code 23900 covers interthoracoscapular amputation, a surgical procedure involving the removal of the upper arm and shoulder blade (scapula) in one block, typically performed for severe trauma, malignant tumors, or advanced infection that cannot be treated with limb-salvage techniques.

Showing rates for

National Average

Base Medicare rate

$1,359.20

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

20.72

PE RVU (NF)

17.05

MP RVU

4.25

Total RVU

42.02

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

NCCI bundling edits

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Billing tips

Document medical necessity extensively, including failure of limb-salvage options, tumor characteristics, staging studies, and multidisciplinary team discussions
Impact: Critical for initial payment authorization; lack of medical necessity documentation results in 100% denial ($1359.20 loss)
Consider modifier 22 for increased complexity when extensive chest wall involvement, prior radiation, or complex reconstruction required; attach operative note and detailed letter
Impact: Can increase reimbursement by $270-$680 (20-50% above base rate) with proper documentation
Bill reconstruction procedures separately if performed by different specialty (plastic surgery) using co-surgeon modifier 62
Impact: Ensures both surgeons receive appropriate payment; prevents one surgeon bearing entire procedural cost
Verify prior authorization requirements with all payers before scheduling; most require pre-authorization for major amputations
Impact: Prevents retroactive denials; securing authorization protects full $1359.20 reimbursement
Code any associated lymphadenectomy, tumor excision margins, or frozen sections separately with appropriate modifiers
Impact: Can add $150-$500 in additional reimbursement for pathology and extended surgical services
Ensure operative report includes specific anatomic structures removed (clavicle extent, scapula, neurovascular structures) to support code selection over lesser amputation codes
Impact: Prevents downcoding to lower-paying shoulder disarticulation code 23920; protects full reimbursement differential

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 23900 in 2025?

The 2025 Medicare national average reimbursement for CPT 23900 is $1359.20 for both facility and non-facility settings, based on 42.02 total RVUs and the 2025 conversion factor of 32.3465.

What is the difference between CPT 23900 and 23920?

CPT 23900 (interthoracoscapular amputation) includes removal of the scapula and lateral clavicle along with the upper extremity, while CPT 23920 (shoulder disarticulation) removes only the upper extremity through the glenohumeral joint, leaving the scapula intact. Code 23900 is more extensive and requires documentation of scapular removal.

Does CPT 23900 require prior authorization from insurance?

Most payers including Medicare Advantage plans require prior authorization for CPT 23900 due to the major nature of forequarter amputation. Commercial payers typically mandate pre-authorization with clinical documentation supporting medical necessity, imaging studies, and evidence that limb-salvage is not feasible.

How many RVUs is CPT code 23900 worth in 2025?

CPT 23900 has 42.02 total RVUs in 2025, consisting of 20.72 work RVUs, 17.05 practice expense RVUs, and 4.25 malpractice RVUs. This high RVU value reflects the complexity and risk of forequarter amputation.

What diagnosis codes are appropriate for billing CPT 23900?

Common diagnosis codes include malignant neoplasms of shoulder/upper arm (C40.0x, C49.1x), traumatic amputation necessitating completion (S48.x), osteomyelitis unresponsive to treatment (M86.x), and severe peripheral vascular disease with gangrene (I70.26x). Medical necessity documentation must support why amputation is required.

Can CPT 23900 be billed with modifier 22 for increased complexity?

Yes, modifier 22 is appropriate for CPT 23900 when the procedure involves significantly greater complexity than typical, such as extensive tumor involvement, prior radiation therapy, chest wall reconstruction, or anatomic anomalies. Supporting documentation and a detailed letter must accompany the claim to justify the increased reimbursement request.

What specialties typically perform and bill CPT code 23900?

CPT 23900 is primarily billed by orthopedic oncologists and surgical oncologists who specialize in tumor resection and limb amputation. Trauma surgeons may perform this procedure for severe traumatic injuries, and occasionally general surgeons at tertiary care centers bill this code for life-threatening infections or vascular emergencies.