Radical resection of a tumor from the scapula (shoulder blade), removing the lesion with wide margins of surrounding normal tissue.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,589.21
Total RVUs: 47.58
Global, days: 90
Region: Shoulder

Drawn from CMSNIHFacsAAPC

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Preoperative imaging (CT or MRI) confirming scapular tumor location and Enneking zone (S1, S2, or combined)
Operative note specifying the surgical approach by name and extent of resection (partial vs. total scapulectomy)
Tumor dimensions including the margin of normal tissue required for complete excision, measured at time of resection
Pathology specimen submission with documented margin status and final histologic diagnosis
If modifier 62 used, both surgeons must document their distinct intraoperative roles and medical necessity for co-surgery
If modifier 22 used, documentation of specific factors increasing complexity (e.g., tumor size, neurovascular involvement, prior radiation field)

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

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 23210 covers radical resection of a tumor arising from the scapula, performed with wide margins of normal tissue to achieve oncologically adequate clearance. This is not a simple excision — radical resection implies removal through one or more tissue layers and is reserved for malignant tumors (most commonly chondrosarcoma, Ewing sarcoma, or osteosarcoma) or highly aggressive benign lesions. The Enneking classification guides surgical planning: S1-zone tumors may permit partial scapulectomy, while S2 or combined S1/S2 involvement often requires total scapulectomy with or without glenoid reconstruction.

The 90-day global period covers all routine post-op care from the day before surgery through day 90. Unrelated E/M visits or staged procedures during that window require modifier 24 or 79, respectively. Debridement performed within the same surgical field is bundled and not separately reportable per NCCI policy. Pathology submission of the resected specimen is expected and separately billable; intraoperative imaging integral to the resection is not separately reportable.

Bilateral scapular resection is anatomically implausible in nearly all clinical scenarios, but modifier 50 exists in the code's modifier set for completeness. When two surgeons co-operate due to complexity — common given the neurovascular proximity and reconstructive demands — modifier 62 applies to both surgeon claims. Document the Enneking zone, tumor dimensions, margin status, and the specific surgical approach by name; operative notes that omit these details are the primary audit trigger for this high-RVU code.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	26.53
Practice expense RVU	15.41
Malpractice RVU	5.64
Total RVU	47.58
Medicare national rate	$1,589.21
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	$1,589.21
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 23210 get rejected.

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

Operative note lacks tumor size, margin measurement, or Enneking zone — auditors cannot confirm radical resection was warranted
Debridement or wound closure billed separately when performed in the same surgical field — bundled under NCCI policy
Modifier 22 appended without supporting documentation of what made the procedure significantly more complex than typical
Intraoperative imaging or radiologic guidance billed separately when integral to the resection procedure
Pathology code submitted without a specimen sent, or specimen laterality conflicts with the operative site

Frequently asked questions

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

01What distinguishes radical resection (23210) from a standard excision of a scapular tumor?

Radical resection requires wide margins of normal tissue and typically traverses more than one tissue layer. Standard excision codes are used for benign lesions with narrow or no margins. 23210 is appropriate for malignant tumors or highly aggressive benign connective tissue tumors — not for simple cysts or lipomas near the scapula.

02Can I bill a reconstruction separately if the scapula or glenoid is reconstructed after resection?

Potentially yes, if reconstruction involves a distinct procedure (e.g., custom prosthetic glenoid reconstruction) not bundled with the resection. Document the reconstruction separately and verify NCCI PTP edits between 23210 and the applicable reconstruction code before billing both on the same claim.

03Does the 90-day global period affect billing for post-op physical therapy or oncology management?

Physical therapy billed by a separate PT provider is outside the global and unaffected. Oncology management by a different specialty is also outside the global. The restriction applies to the operating surgeon's own E/M and related follow-up visits — those are bundled unless modifier 24 applies for a clearly unrelated condition.

04When is modifier 62 appropriate for 23210?

Use modifier 62 when two surgeons of equal responsibility co-operate — for example, an orthopedic oncologist and a vascular or thoracic surgeon managing neurovascular exposure. Both surgeons append modifier 62 to 23210 and each submits their own claim. Both operative notes must reflect distinct, necessary roles.

05Is 23210 payable in an ASC setting?

Yes, 23210 is assigned an ASC payment rate. The HOPD rate is significantly higher than the ASC rate — see the Site of Service comparison on this page. Given the complexity of radical scapulectomy, hospital outpatient or inpatient settings are far more common clinically.

06Can debridement be billed separately if extensive tissue debridement was required during the same session?

No. Per NCCI Chapter 4 policy, debridement of muscle or bone in the surgical field of a musculoskeletal tumor excision is not separately reportable. If debridement was unusually extensive, capture it through modifier 22 with supporting documentation rather than a separate debridement code.

Sources & references

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

Mira AI Scribe

The Mira AI Scribe captures the Enneking classification zone, surgical approach by name, tumor dimensions, margin width, tissue layers traversed, and whether reconstruction was performed — directly from dictation. That level of specificity prevents the most common audit flag for 23210: an operative note that confirms a resection occurred but not that it meets the threshold for 'radical' with oncologically adequate margins.

See how Mira captures CPT 23210 documentation