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    OpenPayerBilling CodesRepair, Revision, and/or Reconstruction Procedures on the Neck (Soft Tissues) and ThoraxCPT cpt-21705-scalenus-anticus-muscle-division-cervical-rib-removal
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    CPT 21705: Scalenus Anticus Division with Cervical Rib Removal

    Medicare pays $495 on average nationally for this procedure.

    CPT code 21705 describes surgical division of the scalenus anticus muscle with removal of a cervical rib to treat scalenus anticus syndrome, a procedure performed in an operating room setting for relief of nerve compression in the neck; this is a surgical service involving head and neck soft tissue and bone removal under appropriate anesthesia.

    For related coverage guidance, see recent payer policy updates: Surgical Procedures, Outpatient Surgical Procedures - Site of Service, Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in Adults.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 42-year-old right-handed female presents to a tertiary referral otolaryngology / vascular surgery clinic with a 9-month history of progressive right-sided neck and shoulder pain radiating into the ipsilateral upper extremity, paresthesia in the ulnar distribution, and positional worsening when lifting the arm. Conservative care including physical therapy, activity modification, and analgesics provided minimal relief. Examination demonstrates tenderness over the scalene muscle, positive supraclavicular provocative maneuvers, and focal neck crepitus. Imaging with cervical spine radiographs and dedicated neck CT identifies an anomalous cervical (C7) rib and hypertrophied scalenus anticus compressing the lower brachial plexus.

    The clinical workflow includes preoperative evaluation with history and physical, review of imaging, informed consent discussing scalenectomy and cervical rib resection, preoperative anesthesia assessment, operative scalenus anticus muscle division and cervical rib excision under general anesthesia, immediate postoperative neurovascular assessment, and short inpatient observation or same-day discharge depending on recovery. Postoperative documentation includes operative report with laterality, estimated blood loss, complications, and any applicable modifiers for professional or facility billing. Follow-up includes wound check, physical therapy referral, and neurologic reassessment.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    21470Excision of cervical ribOften performed alone or in conjunction with scalenus anticus division when a cervical rib is present; directly addresses bony contribution to thoracic outlet syndrome
    64585Neuroplasty and/or transposition; brachial plexusMay be performed when brachial plexus neurolysis or transposition is required in addition to scalenectomy
    62287Decompression procedure, cervical nerve rootPerformed when concomitant cervical radiculopathy requires direct cervical decompression in the same operative setting
    36415Collection of venous blood by venipunctureCommon preoperative laboratory procedure performed in the perioperative workflow
    99223Initial hospital care, per day, for the evaluation and management of a patientUsed for higher complexity preoperative or postoperative inpatient E/M services related to the surgical admission

    Related Modifiers

    12 rows

    ModifierDescriptionWhen to Use
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    124Q00000X
    207VB0002X
    207KA0200X
    302F00000X
    311ZA0620X
    224P00000X
    207QA0000X
    2279S1500X

    Related Payer Policy Updates

    Specialty: General Surgery1 / 3

    10 rows

    PolicyPayerEffective Date
    Surgical ProceduresUnitedHealthcare2026-09-01
    Outpatient Surgical Procedures - Site of ServiceUnitedHealthcare2026-09-01
    Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Site of Service for Ambulatory Surgical Procedures (ASC Select)Premera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Outpatient Surgical Procedures - Site of Servicesierra health and life2026-08-01
    Medical Necessity Guidelines — Inpatient Surgical CareMass General Brigham Health Plan2026-08-01
    Ambulatory Surgery Center (ASC) - Site of Care PolicyKaiser Permanente2026-08-01

    Related Codes

    CPT-21685-HYOID-SUSPENSION-FOR-AIRWAY-MANAGEMENT

    CPT 21685: Hyoid Suspension for Airway Support

    CPT-21700-SCALENUS-ANTICUS-MUSCLE-DIVISION-NECK-RELEASE

    CPT 21700: Scalenus Anticus Muscle Division, Neck Surgery

    CPT-21720-STERNOCLEIDOMASTOID-MUSCLE-RELEASE-TORTICOLLIS

    CPT 21720: Sternocleidomastoid Muscle Division for Torticollis

    CPT-21725-STERNOCLEIDOMASTOID-RELEASE-FOR-TORTICOLLIS

    CPT 21725: Sternocleidomastoid Division for Torticollis

    CPT-21740-CHEST-WALL-RECONSTRUCTION-PECTUS-DEFORMITY-REPAIR

    CPT 21740: Chest Wall Reconstruction for Congenital Deformity

    CPT-21742-MINIMALLY-INVASIVE-CHEST-WALL-RECONSTRUCTION-PECTUS

    CPT 21742: Minimally Invasive Chest Wall Reconstruction

    CPT-21743-THORACOSCOPIC-CHEST-WALL-RECONSTRUCTION-PECTUS-REPAIR

    CPT 21743: Thoracoscopic Chest Wall Reconstruction

    CPT-21750-STERNAL-SEPARATION-CLOSURE-STERNAL-REPAIR

    CPT 21750: Closure of Sternal Separation

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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