Excision or curettage of a bone cyst or benign tumor of the clavicle or scapula, with allograft reconstruction of the resulting defect.

Verified May 8, 2026 · 5 sources ↓

Medicare: $596.21
Work RVU: 7.88
Global, days: 90
Region: Shoulder

Drawn from CMSEmednyAAPC

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify the exact anatomic location: clavicle or scapula (code is not valid for proximal humerus — use 23156 for that site).
Confirm allograft use in the operative report; document that autograft was NOT harvested (distinguishes from 23145).
Pathology submission note: document that specimen was sent for analysis, as this supports medical necessity and lesion characterization.
Preoperative imaging (X-ray, CT, or MRI) in the chart supporting presence of a bone cyst or benign tumor at the operative site.
Operative note must name the surgical technique: excision, curettage, or both — generic 'standard approach' language triggers audit flags.
Document allograft source and lot number per tissue bank requirements; some payers require this in the operative record.

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 59 Distinct service LT Left side RT Right side 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 23146 covers surgical removal — by excision or curettage — of a bone cyst or benign tumor located on the clavicle or scapula, where the bony defect created is filled with donor (allograft) bone. This distinguishes it from 23145, which uses autograft. The surgeon excises or scrapes out the lesion, prepares the defect, packs it with allograft material, and typically sends the specimen to pathology. Because allograft procurement and preparation add operative complexity, 23146 sits one step above 23145 in the code family.

The 90-day global period means all routine post-op visits, wound checks, and graft-site management through day 90 are bundled. Anything unrelated to the shoulder bone excision billed in that window needs modifier 24 (E/M) or 79 (unrelated surgical procedure). Per NCCI Chapter 4, debridement within the surgical field is not separately reportable — don't stack 11043 or 11044 on the same claim.

Site of service matters here. The HOPD and ASC payment differentials are significant; see the Site of Service comparison table on this page. If you're billing 23146 with another shoulder procedure on the same day, check NCCI PTP edits before appending modifier 59 or XS — the shoulder is treated as a single anatomic location under NCCI policy.

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 (7.88) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.85) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.88
Practice expense RVU	8.29
Malpractice RVU	1.68
Total RVU	17.85
Medicare national rate	$596.21
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	$596.21
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 23146 get rejected.

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

Wrong anatomic site: billing 23146 for a proximal humerus lesion instead of 23155/23156 causes automatic denial.
Missing allograft documentation: payers deny the upgrade from 23140 if the operative note doesn't explicitly confirm allograft placement.
Lack of medical necessity: no preoperative imaging or pathology plan in the record to justify surgical excision over observation.
Bundling conflict: separately billing debridement (e.g., 11043) performed within the same surgical field — NCCI bundles these.
Global period violation: post-op E/M visits billed without modifier 24, or a related return-to-OR billed without modifier 78.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What's the difference between 23145 and 23146?

Both cover excision or curettage of a bone cyst or benign tumor of the clavicle or scapula. 23145 requires autograft (harvested from the patient); 23146 requires allograft (donor bone). If no graft is used, bill 23140.

02Can I bill 23146 for a lesion on the proximal humerus?

No. Proximal humerus lesions with allograft map to 23156. Using 23146 for a humerus site is a misuse of the code and will deny.

03Is debridement separately billable during the same session as 23146?

No. NCCI Chapter 4 explicitly states that debridement within the surgical field of a bone excision procedure is not separately reportable. Do not stack 11043 or 11044 on the same claim.

04Does the 90-day global include the pathology workup?

The global covers the surgeon's post-op management, not the independent pathology read. The pathology report (88305 or similar) is separately billable by the pathologist or their group — it's outside the surgical global.

05If the patient returns to the OR within 90 days for a wound complication at the same site, what modifier applies?

Use modifier 78 — unplanned return to the OR for a complication related to the original procedure during the global period. Modifier 79 is for an unrelated procedure. Don't invert these.

06Can modifier 22 be used if the tumor was unusually large or adherent?

Yes, but it requires documentation of specific circumstances that increased operative work — time, complexity, bleeding, adherence to neurovascular structures. A generic statement that the case 'took longer' won't survive audit. Quantify the added difficulty in the operative note.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the operative site (clavicle vs. scapula), confirms allograft use and excludes autograft harvest, records the surgical technique (excision or curettage), and flags pathology submission. This prevents the most common 23146 downcode — payers dropping to 23140 when allograft placement isn't explicitly documented in the dictated note.

See how Mira captures CPT 23146 documentation