Excision or curettage of a bone cyst or benign tumor of the clavicle or scapula, with autogenous bone graft harvested from a separate donor site to fill the defect.

Verified May 8, 2026 · 7 sources ↓

Medicare: $657.00
Total RVUs: 19.67
Global, days: 90
Region: Shoulder

Drawn from AAPCFindacodeMdclarityCMSEmedny

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Identify the specific bone involved: clavicle or scapula — payer audits flag notes that only say 'shoulder girdle'
Describe the lesion: type (cyst, benign tumor), dimensions, and radiographic or pre-op imaging correlation
Document the surgical technique: whether excision or curettage was performed and the extent of bone removed
Specify the autograft donor site, harvest method, and volume or size of graft used to fill the defect
Confirm pathology submission of the excised specimen in the operative note
Record pre-op diagnosis with supporting imaging (X-ray, CT, or MRI) confirming benign or cystic nature of lesion

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 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 AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 23145 covers surgical removal or curettage of a bone cyst or benign tumor arising from the clavicle or scapula, where the resulting osseous defect is filled using bone harvested from the patient's own body (autograft). The autograft harvest is integral to this code — it's what separates 23145 from 23140, which covers the same excision without any graft. Do not separately bill a bone graft harvest code when 23145 is reported; the autograft work is bundled.

The specimen is submitted for pathologic analysis. Document the bone of origin (clavicle vs. scapula), the lesion type and size, the curettage or excision technique, the autograft donor site, and the volume of graft used. Operative notes that omit the graft source or conflate this procedure with soft-tissue tumor excision are the primary audit triggers.

The 90-day global period covers all routine post-op care through day 90. A new, unrelated problem presenting during that window requires modifier 24 on the E/M; a staged or planned procedure requires modifier 58; an unplanned return to the OR for an unrelated condition requires modifier 79.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.17
Practice expense RVU	8.55
Malpractice RVU	1.95
Total RVU	19.67
Medicare national rate	$657.00
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	$657.00
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 23145 get rejected.

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

Billing 23145 without documentation of an autograft — payers downcode to 23140 when no graft is recorded
Mismatched ICD-10 diagnosis code: using a malignant neoplasm code with a benign-excision CPT triggers medical necessity denial
Separate billing of bone graft harvest alongside 23145 — the autograft is bundled; unbundling is flagged by NCCI edits
Missing or vague operative note that does not name the specific bone (clavicle vs. scapula), causing code specificity denial
Prior authorization not obtained when required by commercial or Medicaid payers for elective bone tumor excision

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What is the difference between 23145 and 23140?

23140 is the same excision or curettage of a bone cyst or benign tumor of the clavicle or scapula, but without any graft. 23145 requires that an autogenous bone graft was harvested from the patient and used to fill the defect. If no graft was placed, bill 23140. If an allograft was used instead, bill 23146.

02Can I bill a separate bone graft harvest code alongside 23145?

No. The autograft harvest is included in 23145. Billing a separate graft harvest code in addition will be denied or recouped as unbundling under NCCI policy.

03Which modifier applies if the procedure required significantly more work due to lesion size or complexity?

Append modifier 22 and include a separate letter of medical necessity explaining the increased complexity. Document the additional time, difficulty, or anatomical factors in the operative note — payers won't approve modifier 22 without that support.

04What global period applies to 23145, and what does it include?

23145 carries a 90-day global period. That covers the surgery itself, the day-before preoperative visit, and all routine post-op care through day 90 — including wound checks, dressing changes, and suture removal. Unrelated E/M visits in that window need modifier 24.

05Can 23145 be billed bilaterally?

Bilateral clavicle or scapula lesion excisions in the same session are rare but codable. Append modifier 50 if truly bilateral, or LT/RT if only one side. Document each lesion separately in the operative note.

06What ICD-10 codes support 23145 for medical necessity?

Common supporting diagnoses include M85.x1 (fibrous dysplasia), M87.x1 (osteonecrosis), D16.x (benign neoplasm of bone), and M85.4x (solitary bone cyst). Using a malignant neoplasm code will trigger a medical necessity mismatch — 23145 is a benign-lesion excision code.

07Is prior authorization required for 23145?

Medicare generally does not require prior authorization for 23145, but many commercial payers and some state Medicaid programs (including New York Medicaid per eMedNY guidelines) do require it for elective bone tumor excision. Verify with the specific payer before scheduling.

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 or scapula), lesion classification, surgical technique (excision vs. curettage), autograft donor site, and graft volume directly from dictation. This prevents the most common downcode scenario — a claim submitted as 23145 that gets reduced to 23140 because the operative note never documented that autograft was harvested and placed.

See how Mira captures CPT 23145 documentation