CPT code 23490: Clavicle reinforcement, prophylactic stabilization2026 Medicare rate & RVUs in Maryland
Reports preventive surgical stabilization of a weakened clavicle at risk of breaking, rather than treatment of a fracture that has already occurred.
CMS doesn’t publish an office rate for 23490 in Maryland.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 23490 covers
An orthopedic surgeon uses fixation to reinforce a clavicle that is weakened and at risk of fracture, such as from a destructive bone lesion. The service is preventive: the clavicle has not fractured. It may be performed in a hospital or other surgical setting, often in the context of orthopedic oncology care. The operative report should support why the bone was considered at risk and describe the stabilization performed.
Report this code for prophylactic reinforcement of the clavicle, not for fixation of an existing clavicle fracture or an osteotomy performed to correct bone alignment. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. For bilateral procedures, modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 23490 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | Unavailable | $850.34 |
| Rest of Maryland | Unavailable | $801.49 |
| Washington, DC area | Unavailable | $888.52 |
How the 23490 rate is calculated
Each of 23490’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 23490
RVUs × geographic indexes × conversion factor
Work11.86
11.86 RVUs× 1.000 GPCI
Practice expense9.58
9.58 RVUs× 1.000 GPCI
Malpractice2.53
2.53 RVUs× 1.000 GPCI
Adjusted RVUs
23.9700
Conversion factor
$33.4009
Medicare rate
$800.62
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 23490
23490 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 23490
Clavicle reinforcement, prophylactic stabilization
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 23490
Clavicle reinforcement, prophylactic stabilization
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
23490 without 50 · national facility
$800.62
Clavicle reinforcement, prophylactic stabilization
23490-50 · Bilateral: 150%
$1,200.93
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
23490 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 23491Scapular stabilizationProphylactic fixation
- Both codes describe preventive stabilization, but 23490 is specific to the clavicle; 23491 applies to the shoulder area, including the humerus.
- 23500Clavicle fracture careWithout manipulation
- Use 23490 when reinforcing a clavicle before fracture. Code 23500 is for closed treatment of a clavicle fracture that has occurred.
- 23515Clavicle fracture repairOpen treatment
- Code 23490 is preventive. Code 23515 is open treatment of an established clavicle fracture.
23490 billing questions
When is this code appropriate instead of clavicle fracture treatment?
Use it when the surgeon reinforces a weakened clavicle to prevent a fracture. If a fracture is already present, select the applicable fracture-treatment code instead.
How does this differ from code 23491?
Code 23490 is for prophylactic reinforcement of the clavicle. Code 23491 addresses prophylactic treatment in the shoulder area, including the humerus.
What documentation supports reporting this service?
Document the clavicular condition creating fracture risk, the clinical rationale for preventive stabilization, and the operative work performed.
How is bilateral clavicle reinforcement reported?
CMS identifies the service as bilateral, with modifier 50 paid at 150%. The operative documentation should support treatment on both sides.
Does the code include postoperative care?
Yes. Its 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon be paid for this procedure?
CMS permits payment for an assistant at surgery. Co-surgeons and team surgery are not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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