Summary & Overview
CPT 23125: Clavicle (Collarbone) Excision
CPT code 23125 denotes surgical excision of the clavicle, a procedure performed to manage malignant tumors, severe traumatic injury, or intractable infection affecting the collarbone. Nationally, this code captures a high-acuity orthopedic and oncologic service that frequently involves inpatient or ambulatory surgical settings and multidisciplinary perioperative care. Its use has implications for surgical resource planning, case-mix reporting, and payer authorization protocols.
Key payers in the national landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, expected sites of service, and the types of analyses typically applied to this code, including utilization benchmarks, common billing considerations, and relevant policy or authorization trends affecting coverage. The publication does not provide patient-level clinical advice but offers policy and coding clarity for administrators, coders, and clinicians managing care for patients requiring clavicle excision.
What readers will learn: the clinical indication and procedural scope tied to CPT code 23125, the national payer context and stakeholders, where the procedure is commonly performed, and which aspects of billing and policy most often influence coverage and reimbursement decisions. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 23125 describes the surgical excision of the clavicle (collarbone). The procedure involves removal of part or all of the clavicle to treat malignant tumors, severe trauma, or infection.
-
Service type: Surgical procedure — open excision of bone
-
Typical site of service: Hospital operating room or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A 58-year-old male presents with a painful, enlarging mass centered over the medial clavicle with overlying skin erythema and intermittent drainage. Imaging (CT and plain radiographs) demonstrates an osteolytic lesion of the mid-clavicle with cortical breakthrough. Core needle biopsy returns high-grade sarcoma involving the clavicle. The orthopaedic oncologist schedules a partial claviculectomy to excise the involved bone with negative margins. The clinical workflow includes preoperative staging and multidisciplinary tumor board review, informed consent with discussion of risks (bleeding, infection, neurovascular injury, shoulder dysfunction), anesthesia evaluation, preoperative antibiotics, intraoperative excision of the involved clavicular segment with careful preservation or planned reconstruction of adjacent neurovascular structures, hemostasis, possible placement of drains, specimen submission to pathology, postoperative pain control and physical therapy initiation for shoulder girdle motion.
Common settings for this service are the hospital operating room or an ambulatory surgery center for elective benign or limited resections; complex oncologic resections are typically performed in an inpatient hospital operating room with possible overnight admission for monitoring and adjuvant treatment planning.
A typical patient scenario also includes preoperative imaging (CT/MRI), coordination with oncology for adjuvant chemotherapy or radiation when malignant disease is confirmed, and documentation of extent of clavicle removed, laterality, and any concurrent procedures such as soft tissue resection, flap coverage, or skeletal reconstruction.
Coding Specifications
| Modifier | Description | When to Use |
|---|