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    v1.0.28
    OpenPayerBilling CodesExcision Procedures on the ShoulderCPT cpt-23174-proximal-humerus-sequestrum-excision
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    CPT 23174: Excision of Sequestrum, Proximal Humerus

    Medicare pays $739 on average nationally for this procedure.

    CPT code 23174 describes surgical excision of a sequestrum (a dead fragment of bone) from the proximal humerus; this is an operative debridement procedure typically performed by an orthopedic surgeon to remove infected or necrotic bone, categorized as an outpatient or inpatient operative service in the operating room or procedure suite for treatment of osteomyelitis-related bone sequestration.

    For related coverage guidance, see recent payer policy updates: Shoulder Arthroplasty (Total, Partial, Reverse, Revision and Resurfacing), Hip Arthroplasty (partial and total hip replacement), Artificial Lumbar Intervertebral Disc (Lumbar Total Disc Arthroplasty).

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult with chronic osteomyelitis of the proximal humerus presenting with persistent pain, localized swelling, drainage, and episodic fever despite antibiotic therapy. Prior imaging (plain radiographs, CT, or MRI) demonstrates a sequestrum—a well‑demarcated fragment of necrotic bone—near the humeral head. The orthopedic surgeon elects to perform surgical excision of the sequestrum under general or regional anesthesia.

    Preoperative workflow includes history and physical, review of imaging, perioperative labs, and culture-directed antibiotics when indicated. Intraoperative steps involve exposure of the proximal humerus, debridement of infected soft tissue, identification and excision of the sequestrum (23174), irrigation, possible placement of antibiotic cement or drains, and obtaining intraoperative cultures and specimens for pathology. Postoperative care involves pain control, continued targeted antibiotics based on cultures, wound care, and outpatient follow-up with repeat imaging and clinical assessment to ensure resolution of infection and preservation of shoulder function.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    11042Debridement, subcutaneous tissue and fascia (first 20 sq cm or less)May be performed if significant soft tissue debridement is required in conjunction with sequestrum excision.
    11043Debridement, muscle and/or fascia (first 20 sq cm or less)Used when deeper soft tissue (muscle/fascia) debridement is necessary during infection management.
    11044Debridement, bone (includes skin and subcutaneous tissue)Relevant for more extensive osseous debridement beyond focal sequestrum excision.
    23030Excision, deep lesion, upper arm or elbow; complicatedMay be reported for complex lesion excision in the proximal humerus region when soft tissue mass removal is required.
    20610Arthrocentesis, aspiration and/or injection, major joint or bursaMay be used preoperatively for diagnostic aspiration of the shoulder joint to guide management.
    20206Incision and drainage, deep abscess or hematoma, soft tissue of neck, trunk, and extremitiesUsed when I&D of deep abscess is required in the region of the proximal humerus prior to or during sequestrum excision.

    Related Modifiers

    10 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    208000000XPediatrics PhysicianA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
    208100000XPhysical Medicine & Rehabilitation PhysicianPhysical medicine and rehabilitation, also referred to as rehabilitation medicine, is the medical specialty concerned with diagnosing, evaluating, and…
    225XP0019XPhysical Rehabilitation Occupational TherapistOccupational therapists are experts at helping people lead as independent a life as possible. Occupational therapists bring an understanding of the p…
    2278P1006XPulmonary Function Technologist Certified Respiratory TherapistAn individual who is trained and qualified to perform pulmonary diagnostic tests. In the course of conducting these tests, the Pulmonary Function Tec…
    2080I0007XPediatric Clinical & Laboratory Immunology PhysicianA pediatrician who specializes in clinical and laboratory immunology disease management.
    183700000XPharmacy TechnicianA person who works under the direct supervision of a licensed pharmacist and performs many pharmacy-related functions that do not require the professi…
    251300000XLocal Education Agency (LEA)The term local education agency means a public board of education or other public authority legally constituted within a State to either provide admin…

    Related ICD-10-CM Codes

    15 rows

    ICD-10-CM CodeDescription
    A41.9Sepsis, unspecified organism
    B95.61Methicillin susceptible Staphylococcus aureus infection as the cause of diseases classified elsewhere
    M00.011Staphylococcal arthritis, right shoulder
    M00.012Staphylococcal arthritis, left shoulder
    M00.221Other streptococcal arthritis, right elbow
    M00.279Other streptococcal arthritis, unspecified ankle and foot
    M79.2Neuralgia and neuritis, unspecified
    M85.60Other cyst of bone, unspecified site
    M86.00Acute hematogenous osteomyelitis, unspecified site
    M86.10Other acute osteomyelitis, unspecified site

    Showing 1–10 of 15

    Related Payer Policy Updates

    Specialty: Orthopedics/Musculoskeletal1 / 3

    10 rows

    PolicyPayerEffective Date
    Shoulder Arthroplasty (Total, Partial, Reverse, Revision and Resurfacing)univerahealthcare2026-10-15
    Hip Arthroplasty (partial and total hip replacement)univerahealthcare2026-10-15
    Artificial Lumbar Intervertebral Disc (Lumbar Total Disc Arthroplasty)univerahealthcare2026-10-15
    Osteochondral Grafting of the Kneeuniverahealthcare2026-10-15
    Metal-on-Metal Total Hip Resurfacinguniverahealthcare2026-10-15
    Lumbar Fusion (arthrodesis) with decompressionuniverahealthcare2026-10-15
    Sacroiliac Joint Fusion or Stabilizationuniverahealthcare2026-10-15
    Percutaneous Vertebroplasty/Mechanical Vertebral Augmentation and Percutaneous Sacroplastyuniverahealthcare2026-10-15
    Autologous Chondrocyte Implantation (ACI)univerahealthcare2026-10-15
    Shoulder Open ProceduresPremera Bluecross2026-09-04

    Related Codes

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

    CPT 23065: Superficial Soft Tissue Biopsy, Shoulder

    CPT-23066-SHOULDER-DEEP-SOFT-TISSUE-EXCISIONAL-BIOPSY

    CPT 23066: Excisional Biopsy of Deep Soft Tissue, Shoulder

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

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

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

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

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

    CPT 23075: Excision of Subcutaneous Shoulder Mass (<3 cm)

    CPT-23076-SHOULDER-INTRAMUSCULAR-MASS-EXCISION-LESS-THAN-5CM

    CPT 23076: Excision of Intramuscular Shoulder Mass (<5 cm)

    CPT-23077-EXTENSIVE-EXCISION-SHOULDER-SOFT-TISSUE-SARCOMA-LESS-5CM

    CPT 23077: Extensive Excision of Soft Tissue Malignant Tumor, Shoulder

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

    CPT 23078: Extensive Excision of Shoulder Soft Tissue Malignant Tumor

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

    CPT 23100: Open Biopsy of Glenohumeral (Shoulder) Joint

    CPT-23101-ACROMIOCLAVICULAR-STERNOCLAVICULAR-JOINT-DEBRIDEMENT-BIOPSY

    CPT 23101: Acromioclavicular or Sternoclavicular Joint Incision and Biopsy

    Showing 1–10 of 32

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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