Partial excision of the proximal humerus to treat infected or diseased bone, typically performed for osteomyelitis or bone abscess at the shoulder-level humerus.

Verified May 8, 2026 · 6 sources ↓

Medicare: $696.41
Total RVUs: 20.85
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCEmednyCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the surgical technique by name: craterization, saucerization, or diaphysectomy
Confirm anatomic site as proximal humerus — not humeral shaft or humeral head resection
Document the clinical indication (e.g., osteomyelitis, bone abscess) with supporting imaging or culture findings
Record the extent of bone removed and the margins of excision to demonstrate medical necessity
Note intraoperative findings including presence of purulence, sequestrum, or necrotic bone
If cultures or pathology specimens were sent, document that separately — lab processing is not bundled in this code

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 23184 covers partial excision (craterization, saucerization, or diaphysectomy) of the proximal humerus — the techniques used to surgically remove infected, necrotic, or otherwise diseased bone at the top of the upper arm. The classic indication is osteomyelitis or a bone abscess that cannot be managed non-operatively. The surgeon removes the diseased cortical or cancellous bone, creating a saucer-shaped or crater defect to eliminate the nidus of infection and allow healthy tissue to fill the void.

This is a 90-day global procedure. All routine postoperative visits, wound checks, and dressing changes through day 90 are bundled. If you're managing a wound complication or an unrelated condition during that window, use modifier 24 on the E/M or modifier 78 for an unplanned return to the OR for a related issue. Modifier 79 covers an unrelated return-to-OR procedure during the global period.

For site-of-service decisions, there is a significant payment differential between HOPD and ASC settings — see the Site of Service comparison table. Document the specific technique (craterization, saucerization, or diaphysectomy) and the anatomic extent of bone removed; operative notes that describe only vague debridement without technique and location are audit targets.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.65
Practice expense RVU	9.16
Malpractice RVU	2.04
Total RVU	20.85
Medicare national rate	$696.41
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	$696.41
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 23184 get rejected.

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

Wrong code selection: 23195 (humeral head resection) or 23174 (sequestrectomy, humeral head to surgical neck) chosen instead when the clinical scenario overlaps
Insufficient documentation of osteomyelitis or bone abscess diagnosis — payers require corroborating imaging or culture evidence to support medical necessity
Operative note fails to name the specific technique (craterization, saucerization, or diaphysectomy), leaving auditors unable to distinguish this from a more limited debridement
Global period conflict: a related postoperative visit billed without modifier 24, triggering automatic bundle denial
Bilateral procedure billed on two claim lines without modifier 50, causing the second line to deny

Frequently asked questions

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

01How does 23184 differ from 23174 and 23195?

23174 is a sequestrectomy specific to the humeral head-to-surgical-neck region; 23195 is a full humeral head resection. 23184 covers partial excision techniques (craterization, saucerization, diaphysectomy) of the proximal humerus without complete head removal. Choose based on what the surgeon actually did and documented.

02Can 23184 and a shoulder arthroscopy code be billed together on the same day?

Only if they were performed at clearly distinct anatomic sites or at separate encounters. If the open partial excision and any arthroscopic work overlap in site and purpose, NCCI bundling logic applies and you'll need a valid modifier with supporting documentation to justify separate billing.

03What ICD-10 codes typically support 23184?

M86-series osteomyelitis codes (acute, subacute, chronic) localized to the humerus are the primary drivers. Bone abscess of the humerus also supports the claim. Payers will look for imaging or culture evidence to corroborate the diagnosis.

04Is modifier 50 appropriate if the same procedure is done on both humeri in one session?

Yes. Bill a single line with modifier 50 for a bilateral procedure performed in the same operative session. Do not bill two separate line items without it — that will trigger a duplicate-service denial. Reimbursement is capped at 150% of the fee schedule amount.

05What modifier applies if the surgeon returns to the OR within the 90-day global for a wound dehiscence related to the original procedure?

Modifier 78 — unplanned return to the OR for a complication related to the original procedure, during the global period. Do not use modifier 79 here; that modifier is reserved for a return to the OR for an entirely unrelated procedure.

06Does the 90-day global period affect how I bill a separate fracture that occurs postoperatively?

A new traumatic fracture of the same extremity treated during the global period is considered unrelated to the original procedure. Use modifier 79 to bypass the global and bill the fracture treatment separately, with documentation establishing the distinct clinical event.

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 surgical technique (craterization, saucerization, or diaphysectomy), the confirmed anatomic site at the proximal humerus, the clinical indication (osteomyelitis or bone abscess), and intraoperative findings including extent of necrotic or infected bone removed. This prevents the most common audit flag for 23184: an operative note that documents only generic 'debridement' without naming technique or anatomy, which draws downcoding or denial.

See how Mira captures CPT 23184 documentation