Surgical excision or curettage of a bone cyst or benign tumor located at the proximal humerus, including specimen submission for pathological analysis.

Verified May 8, 2026 · 6 sources ↓

Medicare: $632.61
Work RVU: 8.69
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCMdclarityFindacodeCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative note must confirm open approach and identify the lesion as a cyst or benign tumor of the proximal humerus — not just 'shoulder lesion'
Pathology submission documented: specimen sent to lab for histologic analysis
Specify whether bone grafting was performed — if yes, 23150 is the wrong code; use 23156
Laterality documented (left or right humerus) to support LT/RT modifier assignment
Pre-operative imaging (X-ray or MRI) in the record confirming lesion location at proximal humerus
If two surgeons scrubbed, document each surgeon's distinct intraoperative role to support modifier 62

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 23150 covers open excision or curettage of a benign lesion — cyst or tumor — at the proximal humerus. The surgeon removes or scrapes out the lesion, and the specimen goes to pathology. This is an open procedure, not arthroscopic. The 90-day global period covers the operative visit, the day-before visit, and all routine post-op care through day 90.

If bone grafting is required to fill the defect after excision, report 23156 instead — that code captures the added complexity of grafting and is not separately billable alongside 23150. Choosing the wrong code between 23150 and 23156 is a common audit flag. Confirm in the operative note whether grafting was performed before finalizing the code selection.

Site of service matters here. HOPD and ASC reimbursement differ substantially — see the site-of-service comparison table on this page. For Medicare, modifier 62 applies when two surgeons each perform distinct portions of the procedure as co-primaries. Modifier 80 covers a standard assistant surgeon role. If the procedure is performed during the post-op global of a prior related surgery, append modifier 78 (unplanned return, related) or 79 (unrelated procedure) as appropriate.

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 (8.69) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (18.94) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.69
Practice expense RVU	8.4
Malpractice RVU	1.85
Total RVU	18.94
Medicare national rate	$632.61
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	$632.61
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 23150 get rejected.

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

Wrong code selected: grafting performed but 23150 billed instead of 23156
Missing laterality modifier (LT or RT) required by payer — commercial payers frequently reject without it
Diagnosis code doesn't map to a benign lesion — malignant or unspecified neoplasm ICD-10 codes mismatched to this code
Bundling conflict when additional shoulder procedures billed same-day without a modifier to establish distinct service
Lack of pre-operative imaging documentation to support medical necessity of open excision

Frequently asked questions

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

01What is the difference between CPT 23150 and CPT 23156?

23150 covers excision or curettage of the proximal humerus lesion without grafting. 23156 adds bone grafting to fill the post-excision defect. If grafting was performed, 23156 is the correct code — billing 23150 when grafting occurred undercodes the procedure and may trigger a query or audit when the operative note references graft material.

02Does CPT 23150 have a global period?

Yes. 23150 carries a 90-day global period under CMS Physician Fee Schedule 2026. Routine post-op visits, dressing changes, and stitch removals within that window are bundled. Bill modifier 24 for unrelated E/M visits and modifier 78 for an unplanned return to the OR for a related complication during the global.

03Which laterality modifiers are required for 23150?

Append LT for left humerus and RT for right humerus. Most commercial payers and Medicare Advantage plans require laterality on shoulder codes. Missing the modifier is a common clean-claim failure that delays payment.

04Can 23150 be billed with other shoulder procedures on the same day?

Yes, but you need to evaluate NCCI edits for each code pair. When a distinct, separately identifiable procedure is performed on the same shoulder and NCCI allows a modifier, append modifier 59 or an X-modifier (XS for separate structure) to bypass the edit. Do not assume bilateral modifier 50 applies — this is a unilateral bone procedure unless both humeri are operated on.

05What ICD-10 diagnosis codes are typically paired with 23150?

Benign neoplasm codes such as D16.02 (benign neoplasm of scapula and long bones, left upper limb) or D16.01 (right upper limb) are the primary pairings. Unicameral bone cyst codes (M85.31x series) also map appropriately. Avoid unspecified neoplasm or malignant codes — payer systems flag the mismatch against a benign-excision code.

06Is modifier 62 appropriate for CPT 23150?

Modifier 62 applies when two surgeons each perform distinct portions of the procedure as co-primary surgeons and both document their individual intraoperative contributions. For a straightforward proximal humerus lesion excision, co-surgeon billing is unusual and will draw scrutiny without clear operative documentation justifying it.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the lesion type (cyst vs. tumor), its precise anatomical location at the proximal humerus, the surgical approach, whether curettage or full excision was performed, specimen disposition to pathology, and whether bone grafting was used to fill the defect. That last detail — grafting yes or no — directly determines whether 23150 or 23156 is correct. Missing it is the single most common reason this claim gets coded wrong at submission.

See how Mira captures CPT 23150 documentation