CPT 23077 Reimbursement & Benchmarks | OpenPayer

Summary & Overview

CPT 23077: Extensive Excision of Malignant Soft Tissue Tumor, Shoulder

CPT code 23077 denotes an extensive surgical excision of a malignant soft tissue tumor in the shoulder region when the tumor and required margins are under 5 cm. This code captures procedures that extend beyond simple tumor removal to include surrounding tissues and anatomical structures suspected of involvement. The code is relevant nationally for surgical oncology, orthopedic oncology, and general orthopedic services and carries implications for operative planning, anesthesia, site of service selection, and payer coverage policies.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service expectations, payer coverage scope, common billing considerations, and typical sites of service. The publication also highlights benchmarks for utilization, coding nuances relevant to shoulder soft tissue sarcoma excisions, and recent policy updates affecting surgical oncology billing where available.

This summary is intended to orient clinicians, coding professionals, and policy analysts to the clinical intent and billing context of CPT code 23077, provide national-level payer coverage context, and identify the primary areas to review when preparing claims or evaluating reimbursement policy. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 23077soft tissue sarcomasurgical oncologyorthopedic surgeryshoulder surgeryoperative excisionprocedure codingambulatory surgical center

Billing Code Overview

CPT code 23077 describes an extensive excision of a soft tissue malignant tumor (such as a sarcoma) from the shoulder region. The procedure entails removal of the tumor plus surrounding tissue and anatomical structures suspected of involvement, with the combined tumor diameter and required margins measuring less than 5 cm.

Service Type: Surgical excision of malignant soft tissue tumor (extensive)

Typical Site of Service: Hospital operating room or ambulatory surgical center (shoulder/upper extremity surgical service)

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient presents with a progressively enlarging, deep soft-tissue mass in the right shoulder region with biopsy-confirmed high-grade soft tissue sarcoma. Preoperative imaging (MRI of the shoulder and chest CT) demonstrates a tumor measuring 4.2 cm in greatest diameter with suspicious involvement of adjacent deltoid fascia but no distant metastases. The multidisciplinary team (orthopedic oncology and surgical oncology) plans a wide local excision to remove the tumor with oncologic margins while preserving shoulder function. The patient is admitted to an ambulatory surgical center or hospital operating room under general anesthesia. Intraoperative steps include patient positioning, incision planning based on imaging and tumor orientation, en bloc resection of the tumor with surrounding soft tissue and any involved fascia or small portions of adjacent muscle, hemostasis, specimen orientation and labeling for pathology, possible immediate wound reconstruction or placement of drains, and postoperative recovery with pain control and instructions for wound care and oncology follow-up for consideration of adjuvant therapy. Typical site of service is an operating room in an ambulatory surgery center or inpatient hospital surgical suite. Service type is an extensive excision of a malignant soft tissue tumor of the shoulder measuring less than 5 cm in diameter (23077).

Coding Specifications

Modifier	Description	When to Use
`LT`	Left side

CPT 23172: Excision of Sequestrum From Scapula

CPT-23200-RADICAL-RESECTION-CLAVICLE-TUMOR

CPT 23200: Radical Resection of Clavicle Tumor

CPT-23156-PROXIMAL-HUMERUS-CYST-CURETTAGE-BONE-GRAFT

CPT 23156: Excision/Curettage of Proximal Humerus Cyst with Bone Graft

CPT-23220-PROXIMAL-HUMERUS-TUMOR-RESECTION

CPT 23220: Radical Resection of Tumor, Proximal Humerus

CPT-23184-PROXIMAL-HUMERUS-BONE-EXCISION-INFECTION

CPT 23184: Excision of Infected Bone, Proximal Humerus

CPT-23180-PROXIMAL-HUMERUS-INFECTED-BONE-EXCISION

CPT 23180: Excision of Infected Bone, Proximal Humerus

CPT-23125-CLAVICLE-EXCISION-COLLARBONE-RESECTION

CPT 23125: Clavicle (Collarbone) Excision

CPT-23120-PARTIAL-CLAVICULECTOMY-MUMFORD-PROCEDURE

CPT 23120: Partial Claviculectomy (Mumford Procedure)

CPT-23150-PROXIMAL-HUMERUS-BENIGN-LESION-EXCISION-CURETTAGE

CPT 23150: Excision or Curettage of Benign Lesion, Proximal Humerus

CPT-23075-EXCISION-SUBCUTANEOUS-SHOULDER-MASS-LESS-THAN-3CM

CPT 23075: Excision of Subcutaneous Shoulder Mass, Specimen < 3 cm

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Taxonomy Code	Specialty	Notes
207X00000X	Orthopedic Surgery	Orthopedic oncologic surgeons commonly perform resections of shoulder soft tissue sarcomas.
208000000X	General Surgery	Surgical oncologists/general surgeons with soft tissue oncology expertise may perform shoulder tumor excisions.
207L00000X	Plastic and Reconstructive Surgery	Plastic surgeons often participate in reconstruction or complex wound closure after wide excision.
2084P0800X	Surgical Oncology	Surgical oncologists coordinate multidisciplinary oncologic resection and margin management.
208100000X	Otolaryngology—Head & Neck Surgery (note: less common)	Rarely involved for tumors extending into proximal shoulder/neck region; included for completeness.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C49.012`	Malignant neoplasm of connective and soft tissue of right shoulder	Directly identifies a malignant soft tissue tumor in the shoulder and is a primary diagnosis for `23077`.
`C49.011`	Malignant neoplasm of connective and soft tissue of left shoulder	Same relevance for left-sided shoulder tumors.
`C49.9`	Malignant neoplasm of connective and soft tissue, unspecified site	Used when the exact site is unspecified but the pathology indicates soft tissue malignancy requiring excision.
`C47.1`	Malignant neoplasm of peripheral nerves of the upper limb and shoulder	Applies when the tumor arises from peripheral nerve sheaths in the shoulder region and may require similar oncologic excision.
`D48.1`	Neoplasm of uncertain behavior of connective and other soft tissue	May be used preoperatively if the lesion's malignant potential is uncertain pending final pathology but excision is performed for diagnosis and treatment.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11606`	Excision, malignant lesion including margins, trunk, arms, or legs; lesion diameter over 4.0 cm up to 5.0 cm	May be used for skin/dermal malignant lesions of the shoulder region when primary procedure targets cutaneous malignancy rather than deep soft tissue sarcoma; distinguishes superficial skin excisions from deep soft tissue `23077`.
`19307`	Mastectomy, modified radical (includes axillary nodes) (example of adjacent regional procedure)	Not typically performed with `23077` but represents the type of more extensive regional resection when nodal clearance is indicated in other malignancies; included as a comparator for scope of surgery.
`11042`	Debridement; skin, subcutaneous tissue and fascia (first 20 sq cm or less)	May be performed adjunctively if extensive debridement or wound bed preparation is required during the resection or for postoperative wound management.
`15734`	Muscle, myocutaneous flap with microvascular anastomosis	May be used when complex soft tissue reconstruction of the shoulder defect is required after wide excision.
`20610`	Arthrocentesis, aspiration and/or injection, major joint (e.g., shoulder)	May be performed preoperatively for diagnostic purposes or postoperatively for pain management if joint-related issues arise.

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