Summary & Overview
CPT 23485: Clavicle Osteotomy with Bone Graft and Fixation
CPT code 23485 denotes a clavicle osteotomy with bone grafting and possible internal fixation to correct poor clavicular alignment, treat fractures, or repair arthritic damage. This operative code matters nationally because it captures resource-intense orthopedic reconstruction involving operative theater time, graft material, and potential hardware — all factors that influence hospital and payer reimbursement, surgical resource allocation, and quality reporting for upper-extremity procedures. Key payers considered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise framework for understanding clinical indications tied to the code, typical sites of service, and the payer landscape covered in the analysis. The publication provides benchmarks for utilization and reimbursement patterns, highlights relevant policy and coverage considerations that commonly affect claims adjudication, and situates the code within clinical practice pathways for clavicular reconstruction. It also outlines common modifiers used with surgical codes and notes areas where prior authorization or medical necessity documentation frequently applies. Data not available in the input is clearly identified.
Billing Code Overview
CPT code 23485 describes a surgical procedure on the clavicle (collar bone) in which the surgeon incises and reshapes the bone to correct malalignment, shorten or lengthen the clavicle, or address arthritic damage. The procedure includes use of a bone graft and may involve internal fixation of the clavicle.
Service Type
- Orthopedic surgical procedure involving clavicle osteotomy with bone graft and possible internal fixation
Typical Site of Service
- Hospital operating room
- Ambulatory surgical center
- Inpatient surgical suite
Clinical & Coding Specifications
Clinical Context
A 42-year-old male presents with persistent symptomatic midshaft clavicle malunion after a displaced fracture sustained in a motorcycle crash 6 months prior. He reports chronic shoulder pain, visible deformity, and functional limitations with overhead activity despite conservative management including physical therapy. Imaging confirms malalignment with shortening and cortical irregularity. The orthopedic surgeon schedules operative correction: open osteotomy of the clavicle with segmental bone resection and interposition autograft, internal fixation with a precontoured clavicle plate and screws, and intraoperative fluoroscopic confirmation of reduction. The typical clinical workflow includes preoperative evaluation and consent, anesthesia (general or regional), perioperative antibiotics, operative osteotomy/repair with graft and fixation, immediate postoperative radiographs, and short inpatient or ambulatory surgical center recovery with discharge instructions for immobilization and follow-up at 2 weeks for wound check and radiographic surveillance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the clavicle osteotomy with graft and fixation requires substantially greater work than typical (extensive dissection, additional time). |
23 |