Partial excision of the scapula, removing a portion of the bone while preserving the remaining scapular structure.

Verified May 8, 2026 · 5 sources ↓

Medicare: $640.96
Total RVUs: 19.19
Global, days: 90
Region: Shoulder

Drawn from CMSCgsmedicareEmedny

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify which anatomic portion of the scapula was excised (e.g., inferior angle, superomedial border, body, coracoid, acromion if distinct from other codes)
Document the pathologic indication requiring partial excision — tumor, osteomyelitis, snapping scapula, avascular necrosis, or other with supporting imaging
Include pre-operative imaging (X-ray, CT, or MRI) correlating to the operative finding and confirming the partial nature of excision
Operative note must distinguish partial excision from curettage, debridement, or total scapulectomy — volume and margins of bone removed should be described
Record final pathology report when bone was excised for a neoplastic or infectious indication
Document neurovascular structures identified and preserved intraoperatively, particularly the suprascapular nerve and axillary nerve
If performed under general anesthesia in HOPD or ASC, confirm facility site-of-service documentation matches the claim

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 57 Decision for surgery 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 23182 covers surgical partial removal of the scapula — typically performed for bone tumors (benign or low-grade malignant), chronic osteomyelitis, avascular necrosis of a scapular segment, or symptomatic bony prominences causing snapping scapula syndrome. The surgeon removes the diseased or structurally problematic portion of the scapula while preserving as much functional bone as possible. This differs from total scapulectomy and from simple debridement or curettage without structural bone removal.

The 90-day global period covers the operative session, the day-before visit, and all routine post-op care through day 90. Any unrelated E/M service in that window requires modifier 79; a planned staged procedure requires modifier 58; an unplanned return to the OR for a related complication requires modifier 78. If a same-day E/M drove the surgical decision and is separately documented, append modifier 57 to that visit.

Site of service matters here. HOPD and ASC facility payments differ substantially — see the Site of Service comparison on this page. The surgeon's professional fee is the same regardless of setting, but where you schedule the case affects total episode cost and payer scrutiny.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.39
Practice expense RVU	9.02
Malpractice RVU	1.78
Total RVU	19.19
Medicare national rate	$640.96
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	$640.96
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 23182 get rejected.

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

Operative note describes curettage or debridement only — insufficient to support partial excision code level
Lack of pre-operative imaging documentation correlating the surgical indication to the specific scapular anatomy excised
Missing or delayed pathology report when the claim is submitted for tumor-related excision, triggering medical necessity review
Bundling conflict when acromionplasty or distal clavicle excision is billed same-day without a distinct anatomic rationale and modifier 59 or XS
Global period violation — post-op visit billed within 90 days without modifier 24 or 79 demonstrating an unrelated, separately documented service

Frequently asked questions

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

01How does 23182 differ from total scapulectomy?

23182 is partial excision only — a defined segment of the scapula is removed while the remaining bone and shoulder girdle are preserved. Total scapulectomy is coded separately. The operative note must describe which portion was removed to support the partial code.

02Can 23182 be billed same-day as shoulder arthroscopy?

Yes, but expect NCCI scrutiny. If arthroscopy and open partial scapulectomy are performed through distinct approaches for distinct pathologies, modifier 59 or XS documents the separate anatomic site. Without it, the Column 2 code will deny. Confirm your specific code pair in the NCCI PTP lookup before billing.

03Does snapping scapula syndrome support medical necessity for 23182?

Yes, when conservative treatment has failed and imaging documents the bony prominence responsible for scapulothoracic crepitus. Document the trial of physical therapy, the imaging findings, and the intraoperative correlation. Payers vary on how many months of conservative care they require before approving surgical intervention.

04What modifier applies if the surgeon returns to the OR within the global period to address a wound complication from the original partial scapulectomy?

Modifier 78 — unplanned return to the OR for a complication related to the original procedure. Do not use modifier 79 for a related complication; 79 is reserved for unrelated procedures performed during the global period.

05Is prior authorization typically required for 23182?

Most commercial payers require prior authorization for elective bone excision procedures. Medicare does not require prior auth under traditional fee-for-service, but Medicare Advantage plans vary. Check plan-specific requirements before scheduling. For tumor cases, expedited auth pathways may apply.

06How should modifier 22 be applied for an unusually complex partial scapulectomy?

Modifier 22 requires a cover letter explaining what made the procedure significantly more difficult than typical — prior surgery, severe adhesions, distorted anatomy from prior radiation, or unusual tumor extent. Attach the operative note. Without written justification, payers routinely ignore the modifier and pay the base rate.

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 specific scapular region resected, the surgical indication (tumor type, osteomyelitis extent, snapping scapula etiology), neurovascular structures identified and preserved, and whether the excision was partial versus complete. This prevents downcoding to debridement-level codes and closes the documentation gap that triggers medical necessity denials when pathology or imaging correlation is absent from the operative note.

See how Mira captures CPT 23182 documentation