CPT 23532 Reimbursement & Benchmarks | OpenPayer

Summary & Overview

CPT 23532: Open Repair of Sternoclavicular Dislocation with Fascia Graft

CPT code 23532 describes an open surgical procedure for treatment of acute or chronic sternoclavicular dislocation using a fascia graft and internal fixation (pins or screws) to stabilize the joint. This code represents a specialized orthopedic reconstruction procedure that can have significant implications for hospital surgical services, operative resource utilization, and post-operative care. Nationally, accurate coding for complex joint reconstructions like this is important for clinical tracking, quality measurement, and consistent claims processing.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the procedure, common billing modifiers used with this service line, and how the code maps to surgical setting and resource use. The publication summarizes typical sites of service, service line considerations, and national payer coverage patterns where available. It also outlines benchmarks and policy issues relevant to complex orthopedic reconstructions, and highlights operational items for billing teams and revenue cycle professionals.

Data not available in the input for specific associated taxonomies, ICD-10 diagnosis examples, related codes, and payer-specific reimbursement rates. Those items are noted as unavailable and can be supplemented when data is provided.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 23532sternoclavicular dislocationorthopedic surgeryopen repairfascia graftinternal fixationsurgical codinghospital outpatientinpatient surgery

Billing Code Overview

CPT code 23532 describes an open treatment of sternoclavicular dislocation, acute or chronic, using a fascia graft for fixation with internal fixation implants (for example, pins or screws). The procedure addresses a new or recurrent abnormal separation of the sternoclavicular joint and involves surgical reconstruction to restore joint alignment and stability.

Service type: Open surgical reconstruction with graft and internal fixation

Typical site of service: Hospital inpatient or hospital outpatient surgical setting

Clinical & Coding Specifications

Clinical Context

A 42-year-old adult male presents to the emergency department after a bicycle collision with localized pain, deformity, and instability at the sternoclavicular joint. Imaging (radiographs and CT) demonstrates an acute posterior sternoclavicular dislocation with concern for mediastinal impingement. After closed reduction attempts are unsuccessful or deemed unsafe, the patient is taken to the operating room for open treatment of the sternoclavicular dislocation. The orthopedic surgeon performs an open repair using a fascia graft to reconstruct the costoclavicular and sternoclavicular stabilizers and places internal fixation (screws or pins) for fixation.

Preoperative workflow includes history and physical, informed consent, and CT review to assess displacement and vascular/airway risk. Intraoperative workflow includes general anesthesia, open exposure of the sternoclavicular joint, placement of a fascia graft (autograft or allograft) to reconstruct the joint capsule and ligamentous restraints, and implantation of internal fixation devices for stabilization. Postoperative workflow includes perioperative antibiotics, immobilization (sling or figure-of-eight bandage), pain control, and planned outpatient follow-up with radiographs and progressive rehabilitation. Typical site of service is an hospital operating room or ambulatory surgery center depending on acuity and comorbidities. Service type is open surgical treatment of a sternoclavicular dislocation with graft and internal fixation.

Coding Specifications

Modifier	Description	When to Use
`22`

CPT 23615: Open Treatment of Proximal Humerus Neck Fracture

CPT-23525-CLOSED-TREATMENT-STERNOCLAVICULAR-DISLOCATION-MANIPULATION

CPT 23525: Closed Treatment of Sternoclavicular Joint Dislocation with Manipulation

CPT-23655-CLOSED-REDUCTION-SHOULDER-DISLOCATION-ANESTHESIA

CPT 23655: Closed Reduction of Shoulder Dislocation Under Anesthesia

CPT-23585-OPEN-REPAIR-SCAPULAR-FRACTURE

CPT 23585: Open Repair of Scapular (Shoulder Blade) Fracture

CPT-23530-STERNOCLAVICULAR-DISLOCATION-OPEN-FIXATION

CPT 23530: Open Repair, Sternoclavicular Dislocation with Internal Fixation

CPT-23600-CLOSED-TREATMENT-PROXIMAL-HUMERUS-NECK-FRACTURE

CPT 23600: Closed Treatment of Proximal Humerus (Humeral Neck) Fracture

CPT-23550-ACROMIOCLAVICULAR-DISLOCATION-OPEN-FIXATION

CPT 23550: Open Fixation of Acromioclavicular Dislocation

CPT-23552-ACROMIOCLAVICULAR-DISLOCATION-OPEN-RECONSTRUCTION-FASCIA-GRAFT

CPT 23552: Open Reconstruction for Acromioclavicular Dislocation with Fascia Graft

CPT-23605-CLOSED-TREATMENT-HUMERUS-SURGICAL-NECK-FRACTURE

CPT 23605: Closed Treatment of Surgical/Anatomical Neck Fracture of Humerus

CPT-23520-STERNOCLAVICULAR-JOINT-CLOSED-TREATMENT-NONOPERATIVE

CPT 23520: Closed Treatment of Sternoclavicular Joint Dislocation

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Taxonomy Code	Specialty	Notes
207X00000X	Orthopaedic Surgery	Primary specialty performing open sternoclavicular stabilization and fixation.
208000000X	General Surgery	May be involved when mediastinal or thoracic structures are at risk or for combined approaches.
207L00000X	Sports Medicine (Orthopaedic)	Orthopaedic surgeons with sports medicine focus who manage joint instability and reconstruction.
2080S0120X	Thoracic Surgery	Consulted for complex posterior dislocations with mediastinal compromise or if intrathoracic repair is required.
363A00000X	Physician Assistant	Common assistant provider involved in perioperative care and may perform delegated documentation and follow-up.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S43.011A`	Dislocation of right sternoclavicular joint, initial encounter	Acute traumatic dislocation of the sternoclavicular joint often necessitating open reduction and internal fixation when closed reduction fails or is unsafe.
`S43.012A`	Dislocation of left sternoclavicular joint, initial encounter	Same as above for the left side; laterality guides site-specific coding and modifiers like `LT`/`RT`.
`S43.019A`	Dislocation of unspecified sternoclavicular joint, initial encounter	Used when the specific side is not documented at the initial encounter.
`S43.021A`	Posterior dislocation of right sternoclavicular joint, initial encounter	Posterior dislocations risk mediastinal structures and frequently require open surgical management with graft and fixation.
`S43.022A`	Posterior dislocation of left sternoclavicular joint, initial encounter	Left-sided posterior dislocation; clinical risk and surgical indications mirror the right side.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`23700`	Repair, clavicle; open treatment of clavicular fracture, includes internal fixation when performed	May be performed if concomitant clavicle fracture exists or when additional clavicular stabilization is required in the same operative setting.
`23465`	Repair, acute or chronic distal clavicle dislocation; distal claviculectomy or reconstruction (may include graft)	Performed when injury extends to the acromioclavicular/distal clavicle region or for combined shoulder girdle instability.
`20680`	Removal of implant; deep (requiring incision and dissection)	Used for later removal of internal fixation implants (pins or screws) placed during sternoclavicular repair if clinically indicated.
`29826`	Arthroscopy, shoulder, surgical; claviculectomy or distal clavicle excision, when performed arthroscopically	May be performed in related shoulder pathology or for diagnostic arthroscopy if concomitant intraarticular shoulder disease is suspected.
`99024`	Postoperative follow-up visit, global period related	Coded for routine postoperative follow-up visits within the global surgical period as applicable.

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