Summary & Overview

CPT 23155: Humerus Cyst Excision with Autologous Bone Graft

CPT code 23155 denotes excision and curettage of a benign cyst or noncancerous mass from the humerus with defect reconstruction using autologous bone graft and submission of the specimen for laboratory analysis. This orthopedic surgical code captures procedures that address symptomatic bone lesions, structural defects, or diagnostic uncertainty when histologic confirmation is required. Nationally, accurate coding of this service affects clinical documentation, surgical quality measurement, and appropriate payment for combined lesion removal and grafting.

Key payers in the analysis include Aetna, Blue Cross Blue Shield plans, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical description, typical sites of service, and the billing context for this procedure. The publication outlines common modifiers and coding considerations where available, highlights clinical scenarios that typically prompt use of this code (benign humeral lesions requiring curettage and grafting), and notes that the specimen is sent for laboratory evaluation to confirm diagnosis.

This summary provides the clinical context and payer scope for CPT code 23155, supporting billing staff, coders, and policy analysts in aligning documentation with the coded service. Data not available in the input: associated taxonomies, ICD-10 diagnosis mappings, related codes, payer-specific reimbursement benchmarks, and service-line financial metrics.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare23155CPTorthopedic-surgerybone-grafthumeruscurettagesurgical-procedurespecimen-submission

Billing Code Overview

CPT code 23155 describes the surgical removal of a benign cyst or other noncancerous mass from the humerus (upper arm bone) using a cutting or scraping instrument, with the resulting bone defect filled using an autologous bone graft harvested from another site in the patient’s body. The procedure includes submission of the excised specimen for laboratory analysis to confirm its nature.

Service type: Surgical procedure — bone lesion excision with curettage and autologous bone grafting
Typical site of service: Hospital inpatient or outpatient surgical setting or ambulatory surgery center where orthopedic bone procedures and graft harvests are performed

Clinical & Coding Specifications

Clinical Context

A 48-year-old patient presents with progressive proximal upper-arm pain and intermittent swelling after months of activity-related discomfort. Imaging (plain radiographs and MRI) demonstrates a symptomatic benign-appearing intramedullary bone cyst along the proximal humerus with cortical thinning and a small cortical breach. The orthopedic surgeon schedules an operative curettage with autologous bone grafting. In the operating room under general anesthesia, the surgeon makes a deltopectoral approach to the humerus, performs cyst debridement and curettage using curettes and a high-speed burr, sends a representative specimen to pathology for histologic confirmation, and fills the defect with autologous cancellous bone graft harvested from the ipsilateral iliac crest. Hemostasis is achieved, and the wound is closed. Postoperative care includes short-term immobilization, pain control, and radiographic follow-up to document graft incorporation and absence of recurrence. Typical site of service is an inpatient or outpatient hospital operating room or ambulatory surgery center. Service type: surgical, orthopedic procedure involving bone curettage, biopsy submission, and autologous grafting.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, or technical difficulty substantially exceeds typical for `23155`. Documentation must support increased complexity.
`23`	Unusual anesthesia	Use when medically necessary, but general anesthesia is not ordinarily required for `23155` (rare scenarios with severe anxiety or pain control issues).
`26`	Professional component	Use when reporting only the professional interpretation/component (applicable to pathology/technical services reporting scenarios if separated).
`50`	Bilateral procedure	Use when the same procedure `23155` is performed on both upper extremities during the same operative session.
`51`	Multiple procedures	Use when `23155` is reported in addition to other distinct procedures during the same operative session.
`52`	Reduced services	Use when `23155` is partially reduced or not completed as planned (document reason).
`53`	Discontinued procedure	Use when `23155` is started but discontinued due to extenuating circumstances or patient condition.
`59`	Distinct procedural service	Use to indicate a separate and distinct procedure or service from other services on the same day when bundling edits might apply.
`62`	Two surgeons	Use when two surgeons of different specialties work together as primary surgeons performing distinct portions of `23155`.
`80`	Assistant surgeon	Use when an assistant surgeon provides surgical assistance for `23155` (hospital/insurance rules apply).
`81`	Minimum assistant surgeon	Use when a minimal assistant surgeon provides assistance as defined by payer policy for `23155`.
`82`	Assistant surgeon (when qualified resident not available)	Use when a qualified resident is not available and an assistant surgeon is necessary.
`TC`	Technical component	Use when only the technical component of a service is billed (applies primarily to ancillary services like pathology processing if separately billed).
`LT`	Left side	Use to specify the left humerus when laterality is required for `23155`.
`RT`	Right side	Use to specify the right humerus when laterality is required for `23155`.

Taxonomy Code	Specialty	Notes
`207X00000X`	Orthopedic Surgery	Primary specialty performing curettage and bone grafting of the humerus.
`2080P0207X`	Orthopedic Hand Surgery / Upper Extremity (subspecialty)	Surgeons focused on upper extremity pathology; may perform proximal humerus procedures.
`2086S0205X`	Adult Reconstructive Orthopedics	May be involved when structural reconstruction or complex grafting is required.
`2084P0800X`	General Surgery	In some settings, general surgeons with orthopedic interests may perform bone procedures (less common).
`207L00000X`	Surgery - Hand	Applicable when upper-extremity-focused surgeons provide care (alternate taxonomy).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M85.8`	Other specified disorders of bone density and structure	May capture benign focal bone lesions when a more specific code is not available and structural bone disorder is described.
`M89.9`	Disorder of bone, unspecified	General code sometimes used when a specific benign bone cyst or lesion is not otherwise coded.
`M84.30XA`	Stress fracture, unspecified site, initial encounter for stress fracture of unspecified site	Used if curettage and grafting are performed for a pathologic/stress fracture through a cyst in the humerus.
`D16.9`	Benign neoplasm of bone, unspecified	Directly relevant for benign bone tumors or cysts of the humerus requiring curettage and grafting.
`M85.2`	Localized osteolysis	Relevant when a lytic bone lesion (such as a simple bone cyst) produces localized bone loss treated with curettage and grafting.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11010`	Debridement including skin, subcutaneous tissue, muscle and bone of open or septic wound (not typically for sterile bone cyst)	May be used if active infection or extensive necrotic tissue debridement is required in conjunction with `23155`.
`20130`	Excision or curettage of bone cyst or benign bone lesion (other than jaw) — note: anatomical specificity differs	Used for certain bone lesion excisions; selection depends on anatomic and procedural documentation relative to `23155`.
`20930`	Allograft, morselized, or placement of osteopromotive material — first or major (includes obtaining allograft)	Report when an allograft rather than autograft is used to fill the humeral defect instead of autologous grafting described in `23155`.
`20937`	Structural allograft (eg, femoral head)	Use if structural grafting is required to reconstruct a larger humeral defect associated with the curettage.
`27370`	Repair, humerus; open, with internal fixation, when required	Use when additional fixation of the humerus (plate/screws) is performed after curettage and grafting due to fracture or instability.
`20200`	Removal of tumor, soft tissue of bone — excision of tumor of bone (site-specific coding considerations)	May be reported when a distinct tumor excision is performed in conjunction with curettage and grafting of the humerus.