CPT code 23491: Scapular stabilization, prophylactic fixation2026 Medicare rate & RVUs in California
Reports operative stabilization of a structurally weakened scapula to reduce fracture risk, commonly when a bone lesion threatens the bone’s integrity.
CMS doesn’t publish an office rate for 23491 in California.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
Your location
On this page 9 sections
What 23491 covers
This service stabilizes a scapula at risk of fracturing before a fracture occurs. The surgeon reinforces the bone with fixation such as a plate, pins, or wires, with or without bone cement. A typical setting is a hospital operating room, and the procedure may be performed by an orthopedic surgeon, including an orthopedic oncologist, when a lesion has substantially weakened the scapula. The operative note should identify the scapular site, the structural concern and fracture risk, and the stabilization performed.
Report the service for preventive reinforcement, not simply because a scapular lesion is present or because an established fracture is being repaired. Document the indication, laterality, fixation method, and any cement use. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and the others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is 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 23491 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | Unavailable | $941.98 |
| Chico, CA | Unavailable | $933.67 |
| El Centro, CA | Unavailable | $934.17 |
| Fresno, CA | Unavailable | $933.67 |
| Hanford, CA | Unavailable | $933.67 |
| Los Angeles, CA | Unavailable | $989.53 |
| Madera, CA | Unavailable | $933.67 |
| Marin County, CA | Unavailable | $1,076.84 |
| Merced, CA | Unavailable | $933.67 |
| Modesto, CA | Unavailable | $933.67 |
| Napa, CA | Unavailable | $1,033.23 |
| Oxnard, CA | Unavailable | $978.87 |
| Redding, CA | Unavailable | $933.67 |
| Rest of California | Unavailable | $933.67 |
| Riverside, CA | Unavailable | $966.12 |
| Sacramento, CA | Unavailable | $966.99 |
| Salinas, CA | Unavailable | $963.17 |
| San Benito County, CA | Unavailable | $1,103.33 |
| San Diego, CA | Unavailable | $976.73 |
| San Francisco, CA | Unavailable | $1,073.41 |
| San Luis Obispo, CA | Unavailable | $949.28 |
| Santa Clara County, CA | Unavailable | $1,089.31 |
| Santa Cruz, CA | Unavailable | $978.76 |
| Santa Maria, CA | Unavailable | $964.29 |
| Santa Rosa, CA | Unavailable | $987.75 |
| Stockton, CA | Unavailable | $933.67 |
| Vallejo, CA | Unavailable | $1,028.29 |
| Visalia, CA | Unavailable | $933.67 |
| Yuba City, CA | Unavailable | $933.67 |
How the 23491 rate is calculated
Each of 23491’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 · 23491
RVUs × geographic indexes × conversion factor
Work14.18
14.18 RVUs× 1.000 GPCI
Practice expense10.87
10.87 RVUs× 1.000 GPCI
Malpractice3.02
3.02 RVUs× 1.000 GPCI
Adjusted RVUs
28.0700
Conversion factor
$33.4009
Medicare rate
$937.56
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 23491
23491 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 23491
Scapular stabilization, prophylactic fixation
| 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) | 1 | Permitted with supporting documentation. |
| 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 · 23491
Scapular stabilization, prophylactic fixation
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
23491 without 50 · national facility
$937.56
Scapular stabilization, prophylactic fixation
23491-50 · Bilateral: 150%
$1,406.34
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).
23491 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 23490Clavicle reinforcementProphylactic stabilization
- 23490 is the corresponding prophylactic stabilization service for the clavicle. This code is for the scapula.
- 23150Bone lesion removalProximal humerus, no graft
- 23150 addresses curettage or excision of a benign scapular bone lesion; this code addresses preventive reinforcement when the bone is at fracture risk.
- 23155Bone lesion excisionHumerus with autograft
- 23155 describes resection of a scapular tumor. Choose this code for prophylactic stabilization, not tumor removal itself.
23491 billing questions
When is this code appropriate instead of 23490?
Use this code for prophylactic stabilization of the scapula. Code 23490 describes the analogous preventive stabilization of the clavicle.
Is this for a scapular fracture that has already occurred?
It describes preventive reinforcement when the scapula is at risk of fracture. A procedure treating an existing fracture requires the applicable fracture-treatment code instead.
Can removal of the bone lesion also be reported?
A separately performed lesion excision or curettage may be reportable with stabilization. Document each distinct service and check applicable coding edits.
What documentation supports prophylactic stabilization?
Document the scapular site, the lesion or other structural weakness, why fracture risk warrants preventive surgery, and the fixation performed, including laterality and cement use when applicable.
How are bilateral procedures and other same-session procedures paid?
CMS pays bilateral reporting with modifier 50 at 150%. In a same-session multiple-procedure situation, the highest-valued procedure is paid in full and other procedures at 50%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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
Fee sheets · Coming soon
Put 23491 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist