23120 CPT Partial Claviculectomy Reimbursement | OpenPayer

Summary & Overview

CPT 23120: Partial Claviculectomy (Mumford Procedure)

CPT code 23120 represents a partial claviculectomy, commonly known as the Mumford procedure, in which a surgeon removes a segment of the clavicle to relieve pain from chronic acromioclavicular joint conditions such as arthritis and arthrosis. This surgical code is nationally relevant because it captures a targeted shoulder operation performed across hospital inpatient, outpatient, and ambulatory surgical settings, affecting reimbursement, utilization monitoring, and care pathway design for shoulder pain management.

Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, common sites of service, and which payers commonly cover the service. The publication summarizes benchmarking metrics and payment policies where available, highlights relevant coverage considerations and prior authorization patterns, and outlines how the procedure fits into broader musculoskeletal care bundles and surgical care pathways.

The report is intended for healthcare administrators, billing and coding professionals, and clinical leaders seeking a clear understanding of CPT code 23120 — its clinical purpose, payer coverage landscape, and the practical implications for coding and service delivery. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare23120CPTpartial claviculectomyMumford procedureshoulder surgeryorthopedicssurgical codingacromioclavicular joint

Billing Code Overview

CPT code 23120 describes a partial claviculectomy (Mumford procedure). The procedure involves an incision over the shoulder and surgical removal of part of the clavicle (collarbone) to relieve pain from chronic acromioclavicular joint conditions such as arthritis and arthrosis.

Service Type: Surgical procedure — orthopedics/shoulder surgery

Typical Site of Service: Hospital inpatient or outpatient surgical center; ambulatory surgical setting

Clinical & Coding Specifications

Clinical Context

A 58-year-old right-hand-dominant patient presents with months to years of persistent anterior shoulder pain localized to the acromioclavicular (AC) joint, worsened by overhead activity and cross-body adduction. Conservative care including activity modification, nonsteroidal anti-inflammatory drugs, physical therapy, and one or more image-guided corticosteroid injections provided only temporary or incomplete relief. Imaging (plain radiographs or MRI) demonstrates AC joint arthrosis with inferior osteophyte formation and joint space narrowing. The surgeon schedules a partial claviculectomy (Mumford procedure, 23120) to resect the distal clavicle.

Clinical workflow: Preoperative evaluation includes history, focused shoulder exam, and review of prior conservative treatments and imaging. Preoperative optimization and anesthesia evaluation occur in a pre-op clinic or same-day surgery center. The procedure is typically performed in an ambulatory surgery center or hospital operating room under regional block and/or general anesthesia. Intraoperative steps include a shoulder incision centered over the AC joint, subperiosteal elevation, resection of 1–2 cm of the distal clavicle, smoothing of remaining bone, hemostasis, and layered wound closure. Postoperative care includes immediate recovery in PACU, activity restrictions, pain control, and a structured rehabilitation plan with early range-of-motion progressing to strengthening. Typical payors for authorization and claims include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

Coding Specifications

Modifier	Description	When to Use

CPT 23210: Radical Resection of Tumor, Scapula

CPT-23078-EXTENSIVE-EXCISION-SHOULDER-SOFT-TISSUE-SARCOMA-5CM-PLUS

CPT 23078: Extensive Excision of Shoulder Soft Tissue Malignant Tumor

CPT-23125-CLAVICLE-EXCISION-COLLARBONE-RESECTION

CPT 23125: Clavicle (Collarbone) Excision

CPT-23073-SHOULDER-INTRAMUSCULAR-MASS-EXCISION-5CM-OR-GREATER

CPT 23073: Excision of Intramuscular Shoulder Mass, Specimen ≥5 cm

CPT-23105-SHOULDER-SYNOVECTOMY-OPEN-ARTHROTOMY

CPT 23105: Open Shoulder Synovectomy with Synovial Excision

CPT-23145-CLAVICLE-SCAPULA-BENIGN-BONE-LESION-EXCISION-WITH-GRAFT

CPT 23145: Excision of Benign Bone Lesion of Clavicle or Scapula with Graft

CPT-23172-SCAPULAR-SEQUESTRUM-EXCISION-SHOULDER-BLADE

CPT 23172: Excision of Sequestrum From Scapula

CPT-23200-RADICAL-RESECTION-CLAVICLE-TUMOR

CPT 23200: Radical Resection of Clavicle Tumor

CPT-23106-STERNOCLAVICULAR-JOINT-SYNOVECTOMY

CPT 23106: Sternoclavicular Joint Synovectomy

CPT-23140-CLAVICLE-SCAPULA-BENIGN-BONE-LESION-EXCISION

CPT 23140: Excision of Benign Bone Mass or Cyst, Clavicle/Scapula

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Taxonomy Code	Specialty	Notes
`208Z00000X`	Orthopaedic Surgery	Primary specialty performing claviculectomy procedures.
`207L00000X`	General Surgery	May perform shoulder clavicle procedures in some settings.
`221Y00000X`	Physical Medicine & Rehabilitation	Provides perioperative and postoperative nonoperative management and rehab oversight.
`207RH0000X`	Hand Surgery	Fellowship-trained hand/upper-extremity surgeons who may perform distal clavicle resections.
`2084P0802X`	Sports Medicine (Orthopaedic)	Subspecialists who commonly treat AC joint pathology and perform `23120`.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M19.011`	Primary osteoarthritis, right shoulder	Common indication for distal clavicle resection when AC joint degenerative changes cause pain refractory to conservative care.
`M19.012`	Primary osteoarthritis, left shoulder	Same clinical relevance for left-sided AC joint osteoarthritis.
`M75.11`	Rotator cuff tear or rupture of shoulder, partial thickness, right shoulder	Frequently coexists with AC joint disease and may be addressed concurrently.
`M75.12`	Rotator cuff tear or rupture of shoulder, partial thickness, left shoulder	Left-sided counterpart relevant when pathology is contralateral.
`M25.611`	Pain in right shoulder	Symptom code commonly used alongside a definitive diagnosis to support medical necessity.
`M25.612`	Pain in left shoulder	Left-sided symptom code.
`M75.81`	Other shoulder lesions, right shoulder	Includes AC joint lesions and other structural pathology prompting distal clavicle resection.
`M75.82`	Other shoulder lesions, left shoulder	Left-sided counterpart.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`29826`	Arthroscopy, shoulder, distal claviculectomy (Mumford procedure) with distal clavicle resection, when performed arthroscopically	Minimally invasive alternative or adjunct to open `23120`; may be performed before, instead of, or combined with open procedure if arthroscopic approach is used.
`23430`	Tenodesis of long tendon of biceps, open; with or without tenotomy	Performed concurrently if biceps pathology is identified during shoulder surgery and addressed in the same operative session.
`23470`	Repair of complete shoulder (rotator cuff) tendon tear, open	Rotator cuff repair may be performed in the same setting for concomitant shoulder pathology; modifier reporting may be required.
`73030`	Radiologic examination, shoulder; complete, minimum of two views	Preoperative or postoperative imaging to document AC joint degenerative change or evaluate postoperative hardware/complications.
`20610`	Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., shoulder)	Often performed preoperatively diagnostic or therapeutic injection of the AC joint to confirm pain source prior to committing to `23120`.
`99024`	Postoperative follow-up visit, included in global period	Used for routine postoperative follow-up within the global surgical period for minor surgical procedures like `23120`.

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