Clavicle osteotomy with bone graft for nonunion or malunion, with or without internal fixation — graft harvest and any necessary fixation are included in this code.

Verified May 8, 2026 · 8 sources ↓

Medicare: $871.43
Total RVUs: 26.09
Global, days: 90
Region: Shoulder

Drawn from AAPCMdclarityNIHAbosCMS

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Specify whether nonunion or malunion is the primary indication, with supporting imaging (X-ray or CT confirming failed or malpositioned healing)
Document type of bone graft used — autograft source site or allograft — since the descriptor bundles graft harvest but payers audit graft documentation
Describe the osteotomy technique and correction achieved, including any angular or length measurements addressed intraoperatively
State whether internal fixation was placed and the specific implant type (plate, pins, screws), even though fixation is optional within the code
Confirm laterality (left vs. right clavicle) explicitly in the operative note — required for LT/RT modifier use
Document prior treatment history — conservative management, prior ORIF, or elapsed time since original injury — to substantiate nonunion or malunion over acute fracture

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 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 8 cited references ↓

CPT 23485 covers a clavicle osteotomy performed specifically to address nonunion or malunion — situations where a prior fracture failed to heal correctly or healed in a poor position. The surgeon cuts into the clavicle to correct alignment, shorten or lengthen the bone, or address arthritic damage, then uses a bone graft to support healing. Internal fixation may or may not be placed. Critically, the code descriptor explicitly bundles graft harvest and any necessary fixation into the procedure — billing a separate bone graft code (20930–20938) on the same claim will be denied.

The 90-day global period means the surgery, the day-before preoperative visit, and all routine post-op management through day 90 are bundled into a single payment. Anything unrelated billed in that window requires modifier 24 (E/M) or 79 (unrelated procedure). An unplanned return to the OR for a related issue during the global period requires modifier 78.

Code selection between 23485 and 23480 hinges entirely on whether a bone graft was used. If no graft was placed, bill 23480. If the clinical picture looks like a relatively fresh fracture rather than a true nonunion or malunion, 23515 (open treatment of clavicular fracture) may be more accurate — but the operative note must support the additional work inherent in a secondary nonunion repair to justify 23485.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	13.56
Practice expense RVU	9.77
Malpractice RVU	2.76
Total RVU	26.09
Medicare national rate	$871.43
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	$871.43
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$9,004.59

Common denial reasons

The recurring reasons claims for CPT 23485 get rejected.

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

Bone graft code billed separately (20930–20938) when graft harvest is already bundled in 23485 descriptor — payers deny the add-on automatically
Code submitted as 23515 (acute fracture ORIF) when operative note documents nonunion or malunion, or vice versa — clinical documentation must match the chosen code
Missing or ambiguous laterality modifier when payer requires LT or RT for unilateral clavicle procedures
Modifier 22 appended without supporting documentation — operative note must quantify the increased complexity, additional time, or unusual intraoperative findings
Global period violation — post-op E/M or related procedure billed without modifier 24, 78, or 79 within the 90-day window

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01What is the difference between CPT 23480 and 23485?

23480 covers clavicle osteotomy without a bone graft. 23485 is used when bone graft is placed for nonunion or malunion — and it bundles graft harvest into the procedure. Choose based on whether graft was actually used, not on the severity of the deformity.

02Can I separately bill a bone graft code with 23485?

No. The 23485 descriptor explicitly includes obtaining the graft and any necessary fixation. Billing 20930–20938 alongside 23485 will be denied by payers. This is one of the most common claim errors with this code.

03When should I use 23485 instead of 23515 for a clavicle fracture that hasn't healed?

Use 23485 when the operative note documents nonunion or malunion — failed or malaligned healing requiring a secondary repair with bone graft. The additional work of correcting a nonunion distinguishes it from primary fracture care under 23515. Supporting ICD-10 diagnoses should reflect nonunion (M84.31x) rather than an acute fracture.

04Does the 90-day global period apply to 23485?

Yes. The global period is 090 days. Routine post-op visits, dressing changes, and implant management within 90 days are bundled. Append modifier 24 for unrelated E/M services, modifier 78 for an unplanned related return to the OR, and modifier 79 for an unrelated procedure in the global window.

05Is modifier 50 valid for 23485?

Bilateral clavicle osteotomy is exceedingly rare clinically, but modifier 50 is technically applicable if both clavicles are operated on in the same session. Document separate operative indications for each side. Most payers will require LT and RT on separate line items rather than a single line with modifier 50 — verify payer preference before submitting.

06What ICD-10 codes typically support medical necessity for 23485?

M84.31x (stress fracture, nonunion) series, M84.41x (pathological fracture nonunion) series, and M84.0 (malunion of fracture) with the appropriate laterality suffix are the primary supporting diagnoses. Late effects of prior upper extremity fracture (S40–S49 sequela codes) are used as secondary diagnoses to establish the historical injury.

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 indication (nonunion vs. malunion), graft type and harvest site, osteotomy technique, correction achieved, and implant details directly from dictation. This prevents the two most common 23485 audit flags: a vague operative note that doesn't distinguish the procedure from an acute fracture repair (23515), and missing graft documentation that triggers medical necessity reviews even though graft harvest is bundled in the descriptor.

See how Mira captures CPT 23485 documentation