Summary & Overview
CPT 23200: Radical Resection of Clavicle Tumor
CPT code 23200 represents a radical resection of a tumor of the clavicle with submission of the specimen for pathological analysis. As a major oncologic orthopedic procedure, it is performed to remove malignant or high-risk lesions of the clavicle and to obtain tissue for diagnosis and staging. Nationally, this code is relevant to hospitals, ambulatory surgical centers, orthopedic oncology practices, and cancer treatment networks because it marks definitive surgical management of clavicular tumors and triggers surgical, pathology, and perioperative care billing pathways.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for CPT code 23200, typical settings where the service is delivered, and which payers commonly reimburse this service. The publication also covers benchmark considerations, coding and documentation implications for surgical and pathology charges, and policy updates that affect coverage and prior authorization practices. Practical information includes expected care components tied to the code and areas where documentation typically affects reimbursement eligibility.
This summary is written for a national audience of coding professionals, revenue cycle staff, and clinical leadership who need clear, actionable context about CPT code 23200 and its role in oncologic surgical care.
Billing Code Overview
CPT code 23200 describes a radical resection of a tumor of the clavicle (collarbone) with submission of the surgical specimen to a laboratory for pathological analysis. This procedure involves excision of malignant or potentially malignant bone and soft-tissue tumor tissue in the clavicular region.
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Service type: Surgical excision / oncologic orthopedic surgery
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Typical site of service: Hospital operating room or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A 56-year-old patient presents with a progressively enlarging, firm mass involving the left clavicle with localized pain and limited shoulder motion. Imaging (radiographs and MRI) demonstrates a destructive lesion of the medial clavicle concerning for a primary bone sarcoma or metastatic carcinoma. Core needle biopsy was indeterminate; multidisciplinary tumor board recommends a radical resection of the clavicle for oncologic control and definitive diagnosis. The patient is scheduled to undergo 23200 (radical resection of tumor, clavicle). In the operating room, the orthopedic oncologist performs en bloc resection of the involved clavicular segment with wide margins, controls hemorrhage, and sends the specimen to pathology for permanent section and tumor typing. Intraoperative coordination may include anesthesia, surgical oncology, and intraoperative radiology. Postoperatively the patient is monitored in a PACU with planned pathology-driven staging and adjuvant therapy discussion once final pathology returns.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the resection requires substantially greater work or complexity than typical, documented in the operative report. |