Soft tissue repair · Shoulder

23174

Surgical removal of necrotic or infected bone (sequestrum) from the humeral head and surgical neck region, typically performed to treat osteomyelitis or a bone abscess at the proximal humerus.

Verified May 8, 2026 · 7 sources ↓

Medicare
$724.80
Total RVUs
21.7
Global, days
90
Region
Shoulder
Drawn from CMSEmednyBonesupportNIHCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

  • Specify the exact anatomic location as humeral head and/or surgical neck — not just 'proximal humerus'
  • Document the diagnosis driving the procedure (e.g., osteomyelitis, bone abscess) with supporting imaging or culture results
  • Describe the surgical findings, including identification and characterization of the sequestrum (size, extent, appearance)
  • Confirm the surgical approach used and the extent of bone removal performed
  • Record intraoperative cultures or pathology specimens sent, if applicable
  • If modifier 22 is appended, quantify the increased complexity — note time, extent of disease, or technical difficulty explicitly

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service 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

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 23174 describes sequestrectomy of the humeral head through the surgical neck — the open debridement and removal of devitalized, infected, or necrotic bone from the proximal humerus. The procedure is performed for conditions such as osteomyelitis or bone abscess where conservative management has failed and surgical excision of the sequestrum (the dead bone fragment) is required to resolve infection and allow healthy tissue to repopulate the defect.

This code sits within a family of shoulder sequestrectomy codes: 23170 covers the clavicle, 23172 the scapula, and 23174 is specific to the humeral head-to-surgical-neck region. Selecting the wrong code within this family — or defaulting to a partial excision code like 23184 — is a common audit flag. The operative note must clearly identify the anatomic location as the humeral head and/or surgical neck and describe the removal of sequestrum, not simply curettage or saucerization.

The 90-day global period applies. That means routine post-op wound checks, dressing changes, and office management of expected healing are bundled through day 90. If the patient requires a separate unplanned return to the OR for a related complication — such as wound debridement for persistent infection — bill with modifier 78. Antibiotic-impregnated spacer or drug-delivery device placement (add-on code 20700) may be separately reportable when performed at the same session; check current NCCI PTP edits before billing both.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU9.8
Practice expense RVU9.81
Malpractice RVU2.09
Total RVU21.7
Medicare national rate$724.80
Global period90 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

SettingMedicare rate (national)
Office (PFS non-facility)
Procedure performed in physician's office
$724.80
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 23174 get rejected.

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

  • Wrong code selected — 23184 (partial excision, proximal humerus) billed instead of 23174 when the operative note documents sequestrum removal
  • Insufficient documentation of the specific anatomic site; notes reference 'shoulder' or 'proximal humerus' without identifying humeral head or surgical neck
  • Global period billing conflict — post-op services billed without modifier 24 when unrelated, or missing modifier 78 for related return to OR
  • Missing pre-operative imaging or pathology supporting the osteomyelitis or bone abscess diagnosis
  • Medical necessity denial when documentation does not establish failed conservative treatment prior to surgical intervention

Frequently asked questions

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

01What is the difference between CPT 23174 and CPT 23184?
23174 is a sequestrectomy — removal of a discrete dead bone fragment (sequestrum) from the humeral head to surgical neck. 23184 is a partial excision (craterization, saucerization, or diaphysectomy) of the proximal humerus. The procedures are distinct; select the code that matches what was actually performed and documented, not what is anatomically adjacent.
02Can I bill 20700 (antibiotic spacer preparation and insertion) with 23174?
20700 is listed as an add-on code used in conjunction with 23174 when an antibiotic drug-delivery device is placed at the same session. Verify the current NCCI PTP edit status before billing both — modifier indicators can change quarterly. Document the preparation and insertion of the device separately in the operative note.
03What modifier applies if the patient returns to the OR during the 90-day global for persistent osteomyelitis?
Use modifier 78 for an unplanned return to the OR for a related procedure during the post-op period of 23174. If the return procedure is entirely unrelated to the original infection, use modifier 79 instead. Do not use 78 and 79 interchangeably — the distinction is audited.
04Does the site of service affect reimbursement for 23174?
Yes. HOPD and ASC payments differ significantly from the facility fee schedule — see the site-of-service comparison on this page. The physician's professional fee is also site-of-service adjusted under the 2026 CMS Physician Fee Schedule; the non-facility RVU is higher than the facility RVU, reflecting reduced overhead when performed outside a hospital.
05When is modifier 22 appropriate for 23174?
Append modifier 22 when the procedure required substantially more work than typical — for example, extensive disease involvement, severe scarring from prior surgery, or a much larger sequestrum than anticipated. The operative note must quantify or describe the increased complexity explicitly. Without supporting documentation, payers will strip the modifier and reprocess at standard rate.
06Is 23174 ever performed bilaterally, and how should that be billed?
Bilateral sequestrectomy of the humeral head is exceedingly rare clinically, but if performed, append modifier 50 to a single line and document symmetric pathology in both operative notes. Some payers require two separate line items with LT and RT instead — verify payer-specific billing rules before submitting.

Sources & references

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

  1. 01CMS Physician Fee Schedule 2026
  2. 02
    cms.gov
    https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-policy-manual
  3. 03
    cms.gov
    https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-faq-library
  4. 04
    emedny.org
    https://www.emedny.org/providermanuals/physician/pdfs/physician%20procedure%20codes%20sect5.pdf
  5. 05
    bonesupport.com
    https://www.bonesupport.com/wp-content/uploads/2025/10/PR-01297-04-en-US-09-2025-2025-Inpatient-Coding-Guide.pdf
  6. 06
    pmc.ncbi.nlm.nih.gov
    https://pmc.ncbi.nlm.nih.gov/articles/PMC12088279/
  7. 07
    cgsmedicare.com
    https://www.cgsmedicare.com/medicare_dynamic/j15/partb/ptpb/ptp.aspx

Mira AI Scribe

Mira's AI scribe captures the anatomic site (humeral head to surgical neck), the surgical indication (osteomyelitis, bone abscess), a description of the sequestrum identified and removed, the extent of debridement, and any specimens sent to pathology. This prevents the most common denial driver for 23174: operative notes that reference 'proximal humerus' without specifying the humeral head or surgical neck, which auditors use to downcode or reject the claim entirely.

See how Mira captures CPT 23174 documentation

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