No office rate
Both describe radical tumor resection, but 23200 identifies the clavicle as the operative site; 23220 identifies the proximal humerus.
On this page
CMS RVU26D · Effective 2026-10-01
23220 Tumor resection Medicare reimbursement rates in Indiana
Reports radical oncologic removal of a tumor involving the proximal humerus when the operation requires resection rather than limited curettage. Compare 23220 office and facility rates across CMS payment localities in Indiana.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 23220 in Indiana?
Indiana has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1590.27
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Orthopedic oncology
About 23220: Radical proximal humerus tumor resection
Reports radical oncologic removal of a tumor involving the proximal humerus when the operation requires resection rather than limited curettage.
This code describes an extensive oncologic operation to remove a tumor involving the upper end of the humerus, often as limb-sparing treatment for a primary bone tumor. An orthopedic oncologist typically performs the procedure in a hospital operating room. The operative approach and amount of bone and surrounding tissue removed depend on the tumor’s location and extent; reconstruction may be part of the overall surgical plan.
Choose this service for radical resection, not a limited excision or curettage. The operative report should identify the affected side and proximal humerus, describe the tumor and the extent of resection, and support the radical nature of the procedure. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 supports bilateral reporting at 150%. Assistant-at-surgery payment may be allowed; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 23220
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU29.45 · 57%
- Practice expense (office) RVU16.31 · 31%
- Malpractice RVU6.26 · 12%
124
Medicare services in 2024 · #4705 by national volume
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.
23220 compared with similar codes
Office rates for Indiana, from the same CMS release.
No office rate
Both describe radical tumor resection, but 23210 applies to the scapula rather than the proximal humerus.
No office rate
This code is for a more limited proximal humerus curettage or excision of a bone cyst or benign tumor, rather than radical oncologic resection.
Compare 23220 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Indiana →
Office / nonfacility
Unavailable
Facility
$1590.27
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 23220 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
2,187
- Code
- 23220
- Physician work
- 29.45
- Practice expense
- 16.31
- Malpractice
- 6.26
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 29.45 | × 1.000 | 29.4500 |
| Practice expense | 16.31 | × 0.927 | 15.1194 |
| Malpractice | 6.26 | × 0.486 | 3.0424 |
| Total RVUs | 47.6117 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Indiana$1590.27
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 29.45 | 1 |
| Practice expense | 16.31 | 0.927 |
| Malpractice | 6.26 | 0.486 |
(29.45 × 1 + 16.31 × 0.927 + 6.26 × 0.486) × $33.4009 = $1590.27
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
23220 billing questions
How does this differ from a proximal humerus curettage code?
Use this code for radical oncologic resection of the tumor-bearing proximal humerus. A limited curettage or excision of a bone cyst or benign tumor is a different service.
What should the operative report document?
Document the side, tumor location in the proximal humerus, and the extent of the radical resection. The report should make clear why the operation was more extensive than curettage.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can modifier 50 be used for bilateral procedures?
CMS identifies this as a bilateral procedure; modifier 50 is paid at 150% when the procedure is performed bilaterally.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be allowed. Co-surgeon payment requires supporting documentation; team surgery is 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
2,18423195,,Resection humeral head,A,,10.10,9.00,NA,9.00,,2.15,21.25,21.25,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,18523200,,Radical rescj tumor clavicle,A,,22.14,14.01,NA,14.01,,4.73,40.88,40.88,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,18623210,,Radical rescj tumor scapula,A,,26.53,15.41,NA,15.41,,5.64,47.58,47.58,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,18723220,,Radical rescj tumor prox hum,A,,29.45,16.31,NA,16.31,,6.26,52.02,52.02,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,18823330,,Remove shoulder foreign body,A,,1.85,7.58,,2.73,,0.40,9.83,4.98,0,010,0.10,0.80,0.10,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,18923333,,Remove shoulder fb deep,A,,5.85,6.66,NA,6.66,,1.25,13.76,13.76,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,19023334,,Shoulder prosthesis removal,A,,15.11,11.05,NA,11.05,,3.06,29.22,29.22,0,090,0.10,0.69,0.21,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915