Open surgical removal of the entire clavicle, performed for malignant tumors, extensive trauma, or severe infection where partial resection is insufficient.

Verified May 8, 2026 · 6 sources ↓

Medicare: $669.02
Total RVUs: 20.03
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCFindacodeAbosAoassn

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Operative report explicitly states total (complete) clavicle excision, not partial or distal resection
Named pathologic indication documented: bone metastasis, osteomyelitis, or traumatic destruction severity
Surgical approach described by name and extent — auditors flag notes that say only 'standard open approach'
Laterality specified (left, right, or bilateral) with corresponding modifier noted
Pre-operative imaging or pathology confirming extent of disease, supporting medical necessity for total vs. partial resection
Post-op plan documented, including reconstruction or soft tissue management if applicable

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 23125 covers total claviculectomy — complete open excision of the clavicle. Because the clavicle articulates rigidly at both the sternoclavicular and acromioclavicular joints, total removal is a major reconstruction and reserved for conditions that make partial resection inadequate: bone metastasis, extensive osteomyelitis, or severe traumatic destruction. This distinguishes it from 23120 (partial claviculectomy), which handles distal-end resections at the AC joint, and from 23130 (acromioplasty/acromionectomy), which involves the acromion, not the clavicle.

The 90-day global period applies. All routine post-op management, wound checks, and dressing changes through day 90 are bundled. Services unrelated to the claviculectomy billed within that window require modifier 24. A new significant problem evaluated at a post-op visit requires modifier 25 on the E/M.

For bilateral procedures, Medicare reimburses at 150% for bilateral total claviculectomy (use modifier 50); most commercial payers follow the same rule. For unilateral cases, append LT or RT. Operative reports must document the full extent of resection — total versus partial — to justify 23125 over 23120. Auditors will compare the op note to the code; 'complete excision' language tied to a named pathologic indication is your defense.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.4
Practice expense RVU	8.63
Malpractice RVU	2
Total RVU	20.03
Medicare national rate	$669.02
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$669.02
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 23125 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Code billed as 23125 but op note describes only distal clavicle excision — should be 23120
Missing laterality modifier (LT, RT, or 50) causing claim rejection on first pass
Diagnosis code does not support total claviculectomy — localized AC joint arthritis supports 23120, not 23125
Unrelated E/M billed during 90-day global without modifier 24, triggering automatic bundling denial
Bilateral claim submitted without modifier 50; payer cannot identify bilateral intent and pays for one side only

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What separates 23125 from 23120?

23120 is partial claviculectomy — most often the distal end at the AC joint. 23125 is total removal of the entire clavicle. The distinction is anatomic and must be explicit in the operative report. If the note describes distal resection only, 23120 is the correct code regardless of what is billed.

02Can 23125 and 23130 be billed together?

23130 involves the acromion, not the clavicle. If both the entire clavicle and a portion of the acromion are resected in the same session for distinct indications, billing both with modifier 59 on 23130 may be appropriate — but document separate operative necessity for each structure. Check NCCI edits before submitting.

03How is a bilateral total claviculectomy reimbursed under Medicare?

Medicare pays 150% of the single-procedure rate for bilateral total claviculectomy (modifier 50). This is different from bilateral partial claviculectomy, which Medicare pays at the same rate as a unilateral partial — no additional reimbursement for the second side.

04What diagnosis codes support 23125 medical necessity?

Bone metastasis (e.g., C79.51), chronic osteomyelitis of the clavicle (e.g., M86.612), or severe traumatic clavicle pathology are the primary supporting diagnoses. AC joint osteoarthritis alone supports 23120, not 23125. Mismatch between diagnosis and procedure code is a top denial trigger.

05What modifier applies if a complication requires return to the OR within the 90-day global?

If the return is for a complication related to the original claviculectomy, use modifier 78. If the new procedure is unrelated to the claviculectomy, use modifier 79. Do not invert these — modifier 78 is strictly for related unplanned returns, modifier 79 for unrelated procedures during the global period.

06Is 23125 ever performed arthroscopically?

No. Total claviculectomy is an open procedure by definition — the clavicle's bilateral bony articulations require open exposure for complete excision. Arthroscopic distal clavicle resection maps to 29824, not 23125.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the full extent of clavicle resection (total vs. partial), the named pathologic indication (e.g., metastatic lesion, chronic osteomyelitis, traumatic destruction), surgical approach, and laterality directly from dictation. This prevents the most common audit flag for 23125: operative notes that document a distal or partial resection but bill for total claviculectomy, or notes that name only 'tumor' without specifying the extent requiring complete removal.

See how Mira captures CPT 23125 documentation