Summary & Overview
CPT 23900: Forequarter Amputation, Upper Extremity and Shoulder Girdle
CPT code 23900 represents a forequarter amputation: surgical removal of the upper extremity together with the scapula and clavicle, typically performed for extensive shoulder girdle malignancies. This high-acuity procedure has significant clinical and resource implications, including complex perioperative care, prolonged inpatient stays, and coordination across surgical oncology, vascular, plastic/reconstructive, and rehabilitative services. Nationally, 23900 is important for tracking utilization of major oncologic amputations and for ensuring appropriate coverage, payment, and care pathways for rare but high-cost cases.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for forequarter amputation, typical sites of service and care settings, common billing modifiers associated with major surgical procedures, and guidance on where to find related coding references. The publication summarizes available benchmarks and payer coverage considerations where data exist, highlights policy and documentation priorities tied to high-complexity surgery, and outlines clinical and administrative factors that affect claims processing and payment. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 23900 describes a forequarter amputation, a surgical procedure that removes the entire upper extremity including the scapula (shoulder blade) and clavicle (collar bone). This operation is typically performed for extensive malignant disease of the shoulder girdle, such as bone cancer, when limb-sparing approaches are not feasible.
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Service type: Major surgical resection and amputation of the upper extremity and shoulder girdle.
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Typical site of service: Inpatient hospital operating room with postoperative inpatient care, often involving multidisciplinary surgical and oncologic teams.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a primary malignant bone tumor of the proximal humerus, scapula, or clavicle (for example, high-grade osteosarcoma or chondrosarcoma) that is locally advanced, involves neurovascular bundle structures, or has failed limb-sparing surgery and reconstruction. The patient presents with progressive pain, a palpable mass, functional loss of the shoulder and arm, and imaging demonstrating tumor extent. Workup includes history and physical, plain radiographs, MRI to define local extent, CT for chest metastasis survey, biopsy (core or open) confirming histology, and multidisciplinary tumor board review including orthopedic oncology, medical oncology, radiation oncology, and vascular surgery if needed. Preoperative optimization includes anesthesia evaluation, blood typing and crossmatch, venous thromboembolism prophylaxis planning, and discussion of prosthetic/rehabilitation needs and goals.
The operative workflow for 23900 (forequarter amputation) includes general endotracheal anesthesia, prone or supine positioning depending on surgeon preference and tumor location, wide oncologic margins with en bloc removal of the upper extremity including the scapula and clavicle, ligation of major neurovascular structures, hemostasis often requiring vascular control or reconstruction, placement of drains, and layered closure with possible myocutaneous flap or skin grafting. Postoperative care is in a monitored setting with pain control, wound care, early physical and occupational therapy focusing on prosthetic planning and activities of daily living training, and coordination of adjuvant oncologic therapy as indicated.
Coding Specifications
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