CPT 23146 Excision with Graft Reimbursement | OpenPayer

Summary & Overview

CPT 23146: Excision of Benign Bone Lesion of Clavicle or Scapula

CPT code 23146 denotes surgical excision or curettage of a benign bone lesion or cyst of the clavicle or scapula with placement of donor bone graft and submission of the specimen for laboratory analysis. This procedure-level code captures operative management of noncancerous osseous masses in the shoulder girdle and is relevant across surgical orthopedics and hand/upper-extremity specialties. Nationally, accurate use of CPT code 23146 supports appropriate documentation of resource use, pathology follow-up, and surgical outcomes tracking.

Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage patterns and benchmarking where available, common billing considerations, and clinical context for coding selection. Readers will find a concise explanation of the clinical scenario represented by the code, typical sites of service, and how the code fits into surgical care pathways for benign bone lesions of the clavicle and scapula. The report also highlights areas where policy updates or payer-specific edits commonly affect claim adjudication. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 23146bone lesion excisionclavicle surgeryscapula surgerybone graftsurgical codingorthopedic surgerypathology specimen

Billing Code Overview

CPT code 23146 describes surgical removal of a noncancerous mass or cyst involving the clavicle (collarbone) or scapula (shoulder blade) through excision or scraping of bone, with the resulting bone defect filled using donor bone graft. The procedure includes submission of the excised specimen to a laboratory for pathological analysis.

Service type: Surgical procedure — bone lesion excision with bone grafting and specimen submission
Typical site of service: Hospital operating room or ambulatory surgery center (procedures involving bone excision and grafting are typically performed in an inpatient or outpatient surgical setting)

Clinical & Coding Specifications

Clinical Context

A 52-year-old patient presents with a progressively enlarging, non-tender bony mass over the clavicle discovered on clinical exam and confirmed on radiographs and CT to be a benign osteochondroma arising from the distal clavicle. Conservative measures failed and the lesion causes shoulder impingement and cosmetic concern. The orthopedic surgeon schedules an operative excision under general anesthesia in an outpatient surgical center. Intraoperatively the surgeon performs en bloc excision and curettage of the lesion from the clavicle, sends specimen to pathology for histologic confirmation, and performs structural grafting using autograft or allograft bone to fill the resultant cortical defect. The procedure requires preoperative consent, imaging review, intraoperative specimen handling (surgical pathology TC/26 considerations), and postoperative outpatient recovery with activity restrictions. Typical site of service is an ambulatory surgery center or hospital outpatient department depending on patient comorbidities and anesthesia needs.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the surgeon’s professional service separate from a facility technical component for pathology or radiology associated with the procedure.

CPT 23184: Excision of Infected Bone, Proximal Humerus

CPT-23155-HUMERUS-CYST-EXCISION-WITH-BONE-GRAFT

CPT 23155: Humerus Cyst Excision with Autologous Bone Graft

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

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

CPT-23210-RADICAL-SCAPULA-TUMOR-RESECTION

CPT 23210: Radical Resection of Tumor, Scapula

CPT-23100-SHOULDER-GLENOHUMERAL-JOINT-BIOPSY-OPEN

CPT 23100: Open Biopsy of Glenohumeral (Shoulder) Joint

CPT-23105-SHOULDER-SYNOVECTOMY-OPEN-ARTHROTOMY

CPT 23105: Open Shoulder Synovectomy with Synovial Excision

CPT-23065-SHOULDER-SUPERFICIAL-SOFT-TISSUE-BIOPSY

CPT 23065: Superficial Soft Tissue Biopsy, Shoulder

CPT-23071-SHOULDER-SOFT-TISSUE-MASS-EXCISION-3CM-OR-GREATER

CPT 23071: Excision of Shoulder Soft-Tissue Mass, ≥3 cm

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

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Taxonomy Code	Specialty	Notes
207L00000X	Orthopaedic Surgery	Primary specialty performing clavicle/scapula bone lesion excision and bone grafting.
207XS0112X	Orthopedic Trauma	Manages complex bony lesions, reconstruction and grafting when structural integrity is a concern.
208100000X	General Surgery	May perform resection of superficial bone lesions depending on practice scope and setting.
207K00000X	Orthopedic Hand Surgery	Applicable when lesion involves distal clavicle with shoulder girdle/AC joint implications; may participate in complex reconstruction.
208000000X	Surgery - Other	Other surgical specialists performing bone lesion excisions in multidisciplinary settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M89.80`	Disorder of bone, unspecified site, not elsewhere classified	General code for benign bone lesions when more specific code not available; may be used for clavicular bone lesions pending pathology.
`M85.8`	Other specified disorders of bone density and structure	Used for non-neoplastic structural bone abnormalities that may require curettage and grafting.
`M89.0`	Osteochondritis dissecans	Relevant when osteochondral lesions near the shoulder girdle require excision and grafting.
`M87.8`	Other osteonecrosis	Included when focal bone necrosis presents as a mass-like lesion requiring debridement and grafting.
`D16.9`	Benign neoplasm of bone, unspecified	Common diagnosis for benign bone tumors such as osteochondroma or enchondroma of the clavicle or scapula.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`23101`	Excision, tumor, soft tissue of shoulder area; subcutaneous, simple	May be performed for superficial soft-tissue masses of the shoulder when lesion is not osseous; used when combined soft tissue excision is required.
`11010`	Debridement of skin, subcutaneous tissue and muscle; first 20 sq cm or less	May be used if extensive wound debridement is required prior to or during excision and graft placement.
`20930`	Allograft, morselized, or placement of osteochondral graft	Used to report placement of donor bone graft material to fill osseous defects after excision when allograft is used.
`20936`	Autograft for spine or large defect, structural non-vascularized bone graft	Applied when structural autograft is harvested and placed to reconstruct a clavicular or scapular defect.
`88304`	Surgical pathology, gross and microscopic exam	Used to report the pathologic examination of the submitted specimen from the excision.

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