Excision or curettage of a bone cyst or benign tumor located on the clavicle or scapula, without bone grafting.

Verified May 8, 2026 · 6 sources ↓

Medicare: $531.41
Work RVU: 6.94
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCBonesupportFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify the specific bone involved — clavicle or scapula — by name in the operative note.
Describe the lesion type (cyst, benign tumor, heterotopic ossification) and approximate dimensions.
State explicitly that no bone graft was used; grafting changes the code to 23145 or 23146.
Document surgical approach, extent of excision or curettage, and specimen submission to pathology.
Include pre-op imaging (X-ray, MRI, or CT) in the record confirming benign or cystic nature of the lesion.
Record medical necessity narrative linking symptoms (pain, functional limitation, imaging findings) to the procedure.

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 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 23140 covers open surgical removal or curettage of a bone cyst or benign tumor arising from the clavicle or scapula. The surgeon excises or scrapes out the lesion and typically submits the specimen for pathologic analysis. This code applies only to the clavicle and scapula — lesions on the proximal humerus or acromion are coded differently. If the defect requires autograft or allograft filling after excision, step up to 23145 or 23146 respectively.

The 90-day global period means all routine post-op care through day 90 is bundled. Unrelated E/M visits in that window require modifier 24; a significant, separately identifiable E/M on the day of surgery requires modifier 25. Pathology (88300–88309) is separately reportable when the specimen is sent to the lab — that service is not bundled into 23140.

Site of service matters here: HOPD and ASC payments differ substantially (see the Site of Service comparison table). If the procedure is performed bilaterally in the same session, append modifier 50. When a PA or NP assists, use modifier AS. Document the specific bone involved (clavicle vs. scapula), the lesion type, dimensions, and whether bone grafting was or was not performed — omitting any of these creates audit exposure.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (6.94) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (15.91) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.94
Practice expense RVU	7.5
Malpractice RVU	1.47
Total RVU	15.91
Medicare national rate	$531.41
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	$531.41
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 23140 get rejected.

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

Upcoded to a graft-included variant (23145/23146) without documentation that grafting was performed.
Lesion location documented as proximal humerus or acromion — outside the anatomic scope of 23140.
Missing or inadequate pathology order/specimen documentation when lab analysis was performed.
Routine post-op E/M billed without modifier 24 during the 90-day global period.
Bilateral procedure billed as two separate line items without modifier 50, triggering NCCI edits.

Frequently asked questions

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

01What's the difference between CPT 23140 and 23145 or 23146?

23140 is excision or curettage of the lesion alone — no grafting. 23145 adds autograft (and includes obtaining the graft); 23146 adds allograft. If you fill the defect with any graft material, 23140 is the wrong code.

02Can I bill 23140 for a lesion on the proximal humerus or acromion?

No. 23140 is limited to the clavicle and scapula. Humeral lesions are coded elsewhere in the 23XXX range. Misidentifying the anatomic site is a clean path to denial or audit.

03Is surgical pathology separately billable when the specimen is sent to the lab?

Yes. Pathology codes 88300–88309 are separately reportable and not bundled into 23140. Submit them under the pathologist's NPI, not the operating surgeon's, unless the surgeon personally performs the analysis.

04How do I handle an E/M visit during the 90-day global period that is unrelated to the shoulder procedure?

Append modifier 24 to the E/M code to indicate the visit is unrelated to the operative diagnosis. Without modifier 24, the claim will deny as included in the global surgical package.

05If a PA assists at surgery, how is that billed?

The assisting PA bills under their own NPI with modifier AS appended to 23140. The operating surgeon's claim is unaffected. Some payers require the assistant's claim to reference the surgeon's NPI — verify payer policy before submission.

06Does NCCI bundle simple wound closure into 23140?

Yes. Simple closure (12001–12021) is integral to the excision and is not separately reportable. Intermediate or complex closure may be separately reportable if medically necessary and documented — but simple closure never is.

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 bone of origin (clavicle vs. scapula), lesion morphology and size, surgical technique (excision vs. curettage), whether a bone graft was placed, and specimen disposition from the surgeon's dictation. That prevents the two most common audit flags: missing graft documentation that would require a code change, and an ambiguous anatomic site that auditors use to deny 23140 as miscoded.

See how Mira captures CPT 23140 documentation