Summary & Overview
CPT 23150: Excision or Curettage of Benign Lesion, Proximal Humerus
CPT code 23150 documents the surgical excision or curettage of a noncancerous mass or cyst from the proximal humerus with specimen submission for laboratory analysis. Nationally, this code captures orthopedic procedures for benign bone lesions of the upper arm and is relevant for hospital and ambulatory surgical billing, surgical auditing, and clinical quality measurement. Key payers in common commercial and public markets include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of clinical context and service setting for CPT code 23150, typical payer considerations, and the kinds of benchmarks and policy updates that affect coverage and billing for orthopedic excision procedures. The publication outlines reimbursement benchmark metrics, commonly reported utilization patterns, and recent policy or coding guidance that can influence claim processing. It also summarizes clinical indications and the procedural elements that drive coding specificity and documentation needs. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 23150 describes the surgical removal of a benign (noncancerous) bone lesion or cyst from the proximal humerus. The procedure involves excision or curettage of the lesion from the upper arm bone, with submission of the specimen to a laboratory for pathologic analysis.
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Service type: Surgical excision / bone lesion removal
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Typical site of service: Hospital operating room or ambulatory surgical center (orthopedic surgical setting)
Clinical & Coding Specifications
Clinical Context
A 48-year-old right-handed patient presents with progressive shoulder pain and a palpable, non-tender mass over the proximal humerus. Imaging (plain radiographs and MRI) demonstrates a well-circumscribed, likely benign osseous lesion at the greater tuberosity. Conservative care including activity modification and NSAIDs provided limited relief. The orthopedic surgeon schedules an operative procedure to excise the benign bone lesion with curettage of the proximal humerus and submits the specimen for pathology. The service is performed in an ambulatory surgery center or hospital outpatient setting under regional or general anesthesia. Typical workflow: preoperative evaluation and imaging review, informed consent, intraoperative surgical excision/curettage of the lesion with hemostasis, specimen handling and submission to the pathology lab, wound closure, and postoperative recovery with discharge instructions and scheduled follow-up for pathology results and rehabilitation planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal or typical service | Use when the procedure is performed under routine circumstances without complications. |
22 | Increased procedural services |