Partial surgical removal of the scapula (shoulder blade), typically performed to excise a tumor, debride chronic infection, or address structural deformity while preserving remaining scapular function.

Verified May 8, 2026 · 7 sources ↓

Medicare: $548.44
Work RVU: 7.28
Global, days: 90
Region: Shoulder

Drawn from CMSFastrvuNIHAAOSAoassn

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Operative note must identify the specific scapular segment resected by anatomic name (e.g., superior medial angle, inferior pole) — 'partial scapula' alone is insufficient for audit.
Pathologic indication must be documented preoperatively: biopsy results, imaging findings, or infectious workup supporting the need for bony excision.
Intraoperative description of the extent of resection, including whether adjacent soft tissue or neurovascular structures were encountered or preserved.
Specimen disposition must be noted — pathology submission or intraoperative culture results if infection was the indication.
If modifier 22 is appended, a separate written statement quantifying the additional work and time beyond the typical procedure is required.

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 52 Reduced services 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 23190 covers partial ostectomy of the scapula — a bony excision procedure performed when a discrete portion of the shoulder blade must be removed. Common indications include benign or low-grade osseous tumors, osteomyelitis, and traumatic deformity involving a resectable segment such as the superior medial angle or another defined scapular region. The goal is complete resection of the pathologic bone while preserving enough scapular architecture to maintain shoulder girdle mechanics.

The 90-day global period means all routine postoperative care — wound checks, suture removal, follow-up imaging review related to the procedure — is bundled through day 90. Separate E/M visits within that window require modifier 24 if unrelated to the scapular resection, or modifier 78/79 for any return to the OR. Given the relatively infrequent use of this code across specialties, payers will scrutinize whether the operative note clearly identifies the anatomic segment excised and the pathologic indication driving the resection.

Site-of-service matters here. The HOPD and ASC facility payments differ substantially (see the Site of Service comparison on this page), and because 23190 carries a meaningful work RVU, performing the case in an ASC versus a hospital outpatient department will directly affect the facility fee the patient or payer owes — without changing the surgeon's professional fee.

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 (7.28) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (16.42) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.28
Practice expense RVU	7.6
Malpractice RVU	1.54
Total RVU	16.42
Medicare national rate	$548.44
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	$548.44
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 23190 get rejected.

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

Operative report lacks identification of the specific scapular segment removed, causing a medical necessity mismatch with the ICD-10 diagnosis code.
Missing preoperative imaging or pathology documentation to support the bony excision indication — payers treating it as not medically necessary.
Global period conflict: postoperative E/M claims submitted without modifier 24 when they are unrelated to the scapular resection, triggering automatic denial.
Bilateral modifier 50 applied incorrectly — bilateral scapular ostectomy in a single session is exceedingly rare and will prompt payer review without compelling clinical documentation.

Frequently asked questions

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

01What distinguishes 23190 from 23195 and 23200?

23190 is a partial ostectomy of the scapula — removing a discrete segment. 23195 covers resection of the humeral head. 23200 is a radical resection of the clavicle for tumor. Choose the code that matches the specific bone and extent of resection documented in the operative report.

02Can 23190 be billed with shoulder arthroscopy codes on the same day?

Only if a distinct, separately documented procedure was performed. Append modifier 59 (or the appropriate X-modifier per payer preference) to the secondary code and confirm there is no NCCI bundling conflict. The operative note must support each procedure independently.

03Does the 90-day global period apply when 23190 is done in an ASC?

Yes. The 90-day global period applies to the surgeon's professional fee regardless of facility setting. It does not affect facility billing — ASC and HOPD facility claims are not subject to the surgeon's global.

04When is modifier 22 appropriate for 23190?

When the resection required substantially more work than typical — for example, extensive scar tissue from prior surgery, infected hardware requiring removal, or unusually large tumor with involvement of adjacent soft tissue. Document operative time, complexity, and the specific factors that increased work. Without that narrative, payers will reject the upcharge.

05What ICD-10 codes most commonly support 23190?

Benign bone tumor of scapula (D16.01), osteomyelitis of shoulder region, and traumatic or post-traumatic deformity codes are the primary drivers. The ICD-10 must reflect the pathologic finding confirmed preoperatively — not just shoulder pain or a symptom code.

06Is 23190 subject to SNF consolidated billing?

Yes. CMS consolidated billing rules include 23190 in the SNF PPS bundled payment. Billing this code separately for a patient in a Medicare SNF stay will be denied unless the patient is formally excluded from consolidated billing per CMS policy.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the anatomic segment of the scapula resected, the surgical indication (tumor, infection, or deformity), extent of bony excision, and specimen disposition from the surgeon's dictation. This prevents the most common audit flag for 23190: an operative note that says 'partial scapulectomy' without specifying which portion was removed or why — the combination that triggers medical necessity denials.

See how Mira captures CPT 23190 documentation