No office rate
Both codes describe preventive stabilization, but 23490 is specific to the clavicle; 23491 applies to the shoulder area, including the humerus.
On this page
CMS RVU26D · Effective 2026-10-01
23490 Clavicle reinforcement Medicare reimbursement rates in Pennsylvania
Reports preventive surgical stabilization of a weakened clavicle at risk of breaking, rather than treatment of a fracture that has already occurred. Compare 23490 office and facility rates across CMS payment localities in Pennsylvania.
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 23490 in Pennsylvania?
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$769.73–$837.18
2 of 2 localities have a supported rate.
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 surgery
About 23490: Prophylactic clavicle stabilization
Reports preventive surgical stabilization of a weakened clavicle at risk of breaking, rather than treatment of a fracture that has already occurred.
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.
CMS billing rules for 23490
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU11.86 · 49%
- Practice expense (office) RVU9.58 · 40%
- Malpractice RVU2.53 · 11%
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.
23490 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$243.31–$269.41
Use 23490 when reinforcing a clavicle before fracture. Code 23500 is for closed treatment of a clavicle fracture that has occurred.
No office rate
Code 23490 is preventive. Code 23515 is open treatment of an established clavicle fracture.
Compare 23490 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.
2 of 2 payment localities
Metropolitan Philadelphia →
Office / nonfacility
Unavailable
Facility
$837.18
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$769.73
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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 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.
2,21323474,,Revis reconst shoulder joint,A,,26.53,14.56,NA,14.56,,5.38,46.47,46.47,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,21423480,,Revision of collar bone,A,,11.25,9.22,NA,9.22,,2.40,22.87,22.87,0,090,0.10,0.69,0.21,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,21523485,,Revision of collar bone,A,,13.56,9.77,NA,9.77,,2.76,26.09,26.09,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,21623490,,Reinforce clavicle,A,,11.86,9.58,NA,9.58,,2.53,23.97,23.97,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,21723491,,Reinforce shoulder bones,A,,14.18,10.87,NA,10.87,,3.02,28.07,28.07,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,21823500,,Cltx clavicular fx w/o mnpj,A,,2.15,5.13,,4.74,,0.45,7.73,7.34,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,21923505,,Cltx clavicular fx w/mnpj,A,,3.73,7.70,,5.80,,0.81,12.24,10.34,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00