Summary & Overview
CPT 23106: Sternoclavicular Joint Synovectomy
CPT code 23106 represents a surgical incision and partial synovectomy of the sternoclavicular joint to remove inflamed membranous tissue and, when performed, obtain tissue for laboratory analysis. This joint-level procedure is clinically relevant for patients with inflammatory joint conditions such as rheumatoid arthritis or refractory sternoclavicular pain. Nationally, the code matters for surgical specialty practices, hospital billing, and payers managing benefits for upper thoracic and shoulder-adjacent joint disorders.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context, typical sites of service, and the primary billing considerations associated with this procedure. The publication also outlines benchmarks and policy-relevant points affecting coverage and coding recognition, along with guidance on documentation elements that commonly support medical necessity determinations. The material is intended to inform billing staff, surgical providers, and payer policy teams about the clinical definition and use cases for CPT code 23106 in a national context.
Billing Code Overview
CPT code 23106 describes an incision and partial synovectomy of the sternoclavicular joint, the joint where the breastbone (sternum) meets the collar bone (clavicle). The procedure involves surgically opening the sternoclavicular joint and removing inflamed membranous tissue to relieve pain and inflammation; a tissue sample may be taken for laboratory analysis.
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Service type: Surgical synovectomy / joint procedure
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Typical site of service: Hospital operating room or ambulatory surgical center where minor orthopedic or thoracic joint procedures are performed
Clinical & Coding Specifications
Clinical Context
A 58-year-old female with a multi-year history of seropositive rheumatoid arthritis presents with progressive pain, swelling, and limited range of motion localized to the right sternoclavicular joint. Conservative therapy including oral anti-inflammatory medications, disease-modifying antirheumatic drugs (DMARDs), intra-articular corticosteroid injection, and activity modification produced only transient relief. Imaging with plain radiographs and CT of the sternoclavicular region demonstrates joint space narrowing and synovial hypertrophy without large destructive bone lesions. The orthopedic surgeon schedules an operative debridement and synovectomy of the right sternoclavicular joint to relieve mechanical pain and reduce inflammatory burden.
Preoperative workflow includes surgical consent, review of current DMARD and anticoagulant medications, preoperative labs and anesthesia evaluation. Intraoperatively the surgeon makes an incision over the sternoclavicular joint, performs synovial debridement/partial synovectomy, irrigates the joint, and may obtain a tissue specimen for pathology and/or culture. Postoperative care includes short observation or same-day discharge for an otherwise healthy patient, wound care instructions, analgesia, and planned follow-up to review pathology and monitor wound healing. Typical sites of service are an ambulatory surgery center or hospital outpatient surgery unit. The service type is an operative joint debridement and synovectomy of the sternoclavicular joint performed for inflammatory arthropathy or refractory synovitis.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |