Summary & Overview
CPT 23490: Clavicle Fixation with Internal Implants
CPT code 23490 represents open fixation of a clavicular defect using internal implants such as nails, plates, or screws, and may involve methylmethacrylate bone cement for added stability. This code captures operative management of clavicle fractures or defects that require internal fixation to restore anatomy and function. Nationally, CPT code 23490 is relevant to hospital surgery volumes, orthopedic surgical quality measurement, and payer coverage policies for operative fracture care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical context for when internal fixation of the clavicle is coded, typical sites of service, and the procedural elements captured by the code. The publication outlines common billing modifiers and claims-line considerations where available, benchmarks for utilization and reimbursement (where provided by payers), and policy or coverage topics that affect prior authorization and medical necessity determinations at a national level.
This summary equips coding professionals, surgical practices, and revenue cycle teams with an overview of CPT code 23490, its clinical purpose, and the payer landscape relevant to operative clavicle fixation. Data not available in the input is noted where applicable in detailed sections.
Billing Code Overview
CPT code 23490 describes surgical fixation of a clavicular defect using internal fixation devices such as nails, plates, or screws. The procedure may include the use of methylmethacrylate bone cement for additional stability when indicated.
Service Type: Surgical procedure — open reduction and internal fixation of the clavicle
Typical Site of Service: Hospital operating room or ambulatory surgical center, performed by an orthopedic or trauma surgeon.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting after a fall or motor vehicle collision with acute pain, visible deformity, and limited shoulder motion. Imaging (plain radiographs ± CT) demonstrates a displaced midshaft or lateral clavicle fracture with shortening, comminution, or skin compromise. The surgical workflow includes preoperative evaluation, informed consent, anesthesia (general or regional), open reduction and internal fixation (ORIF) of the clavicular defect using plates, screws, intramedullary nails, or bone cement (methylmethacrylate) for augmentation when indicated, intraoperative fluoroscopic imaging, wound closure, postoperative immobilization (sling), and routine follow-up for wound check and radiographic union assessment. Typical site of service is an inpatient or outpatient hospital operating room; ambulatory surgery center when patient comorbidities and procedure complexity allow. Common clinical indications include acute displaced clavicle fracture, nonunion after conservative management, malunion with functional impairment, or segmental bone loss requiring fixation and augmentation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normally Expected Performed Service | Use when the procedure is performed as planned without unusual circumstances. |
22 |