Radical resection of a clavicle tumor, removing the neoplastic lesion along with a margin of surrounding bone and soft tissue.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,365.43
Total RVUs: 40.88
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCBedrockbillingCgsmedicareAAOS

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Tumor size and location on the clavicle documented in the operative report, including in-situ measurement before resection
Explicit description of the extent of bone and soft tissue resected, justifying the 'radical' approach versus marginal or intralesional techniques
Pathology report or notation that specimen was submitted for histologic analysis
Pre-operative imaging (CT, MRI, or bone scan) confirming the lesion and extent, supporting medical necessity
Clear documentation of surgical margins (negative, close, or positive) in the operative note or pathology report
Diagnosis code supporting a neoplastic or aggressive lesion of the clavicle — benign diagnoses rarely justify a radical approach

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 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

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 23200 covers radical resection of a tumor arising from the clavicle — a procedure reserved for aggressive or malignant neoplasms (sarcoma, metastatic disease, or similarly destructive lesions) where simple excision is insufficient. The surgeon removes the tumor en bloc with a cuff of surrounding tissue to achieve clear margins; the specimen goes to pathology for analysis. This is not a simple curettage or marginal excision — the radical designation means wide or even total claviculectomy may be performed depending on tumor location and extent.

The 90-day global period applies. All routine post-op care through day 90 is bundled. An E/M on the day before or day of surgery requires modifier 57 if that visit is when the surgical decision was made. Any unrelated procedure performed during the global window needs modifier 79; a staged related procedure needs modifier 58. Given the oncologic context, returning to the OR for a related complication (e.g., wound dehiscence, hematoma) is billed with modifier 78.

Site of service matters significantly here. HOPD and ASC payment rates differ — see the Site of Service comparison table on this page. Most payers expect operative reports to specify tumor size, margins, extent of bone resected, and pathology submission. Auditors flag notes that omit margin status or fail to justify the radical (versus marginal) resection approach.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	22.14
Practice expense RVU	14.01
Malpractice RVU	4.73
Total RVU	40.88
Medicare national rate	$1,365.43
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	$1,365.43
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 23200 get rejected.

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

Medical necessity not established — operative note describes a lesion that appears benign or marginal without imaging or biopsy evidence supporting radical resection
Missing or incomplete pathology submission documentation, leading payers to question whether the procedure complexity warrants the code
Operative report uses generic language ('tumor excised') without specifying extent of bone removed or margin intent, triggering downcoding to a less intensive excision code
Diagnosis code mismatch — ICD-10 code does not reflect a malignant or aggressive neoplasm consistent with radical resection
Global period billing errors — routine post-op E/M visits billed without modifier 24, or a staged re-excision billed without modifier 58

Frequently asked questions

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

01What distinguishes CPT 23200 from a lesser clavicle excision code like 23180?

23200 is a radical resection — en bloc removal with a margin of surrounding bone and soft tissue aimed at oncologic clearance. 23180 covers partial clavicle excision for non-neoplastic indications (e.g., chronic osteomyelitis). The diagnosis and operative intent drive the distinction; using 23200 for a non-oncologic resection will draw a medical necessity denial.

02Can 23200 be billed bilaterally?

Bilateral clavicle tumor resection in the same session is exceedingly rare, but if documented and medically justified, append modifier 50 and expect payer scrutiny. Each payer handles bilateral pricing differently — some apply a 150% rule, others price each side separately. Verify before submitting.

03Is modifier 22 appropriate if the resection required vascular or thoracic surgeon involvement?

Yes. If tumor involvement of the subclavian vessels or adjacent structures required substantially greater work than a standard clavicle resection, modifier 22 applies. Document exactly what made the case extraordinary — operative time, blood loss, additional dissection planes, or co-surgeon roles. Expect payers to request the operative report.

04How should a second surgery for positive margins be billed during the 90-day global?

Append modifier 58 — staged or related procedure by the same surgeon during the postoperative period. This resets the global clock. Do not use modifier 78 (that is for unplanned return for a complication, not a planned re-excision for margin control).

05Which ICD-10 codes most commonly support 23200?

Malignant neoplasm of the clavicle (C40.01, C40.11 for primary bone tumor) and secondary malignant neoplasm of bone (C79.51) are the most defensible diagnoses. Benign neoplasm codes may not support radical resection without additional clinical narrative explaining the aggressive behavior or risk justifying the extent of surgery.

06Does the 90-day global include the oncology team's follow-up visits?

The global period bundles the operating surgeon's routine post-op care only. Oncology follow-up by a different physician (e.g., medical oncologist, radiation oncologist) is billed separately under that provider's NPI without a modifier. The surgeon's own unrelated E/M visits during the 90 days need modifier 24.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures tumor size (in-situ measurement), exact anatomic location on the clavicle, extent of bone and soft tissue resected, margin intent (wide vs. radical), and pathology submission confirmation directly from surgeon dictation. That prevents the most common downcoding trigger: an operative note that says 'tumor excised from clavicle' without the detail auditors need to confirm 23200 over a lesser excision code.

See how Mira captures CPT 23200 documentation