No office rate
Choose 23150 for humeral lesion removal or curettage without graft. Choose 23155 when the defect is filled with autograft.
On this page
CMS RVU26D · Effective 2026-10-01
23155 Bone lesion excision Medicare reimbursement rates in Utah
Report this operation when a surgeon removes or curettes a benign bone lesion in the humerus and fills the resulting defect with the patient’s own bone. Compare 23155 office and facility rates across CMS payment localities in Utah.
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 23155 in Utah?
Utah 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
$721.67
1 of 1 localities have a supported rate.
Payment area: Utah
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 surgery
About 23155: Humeral lesion curettage with autograft
Report this operation when a surgeon removes or curettes a benign bone lesion in the humerus and fills the resulting defect with the patient’s own bone.
An orthopedic surgeon exposes the humerus, removes or curettes a bone cyst or benign tumor, and uses the patient’s own bone graft to fill the defect. The service is generally performed in an operating room, including a hospital outpatient department or ambulatory surgery center. The autograft is the distinguishing feature; a similar humeral lesion procedure without graft or with donor bone is coded differently.
Select this code when the operative report supports the humeral site, lesion removal or curettage, and use of autograft. The code has 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. Modifier 50 applies to bilateral procedures, paid at 150%. An assistant at surgery may be paid; co-surgeons are paid only with supporting documentation. Team surgery is not permitted.
CMS billing rules for 23155
- 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 RVU10.59 · 47%
- Practice expense (office) RVU9.57 · 43%
- Malpractice RVU2.25 · 10%
28
Medicare services in 2024 · #5701 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.
23155 compared with similar codes
Office rates for Utah, from the same CMS release.
No office rate
Both address a humeral bone lesion, but 23156 is the allograft option; 23155 identifies use of the patient’s own bone.
No office rate
23184 describes partial excision of proximal humerus. It is distinct from curettage or excision of a bone cyst or benign tumor with autograft.
Compare 23155 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
Utah →
Office / nonfacility
Unavailable
Facility
$721.67
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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 23155 in Utah.
PPRRVU2026_Oct_nonQPP.csv
2,175
- Code
- 23155
- Physician work
- 10.59
- Practice expense
- 9.57
- Malpractice
- 2.25
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 10.59 | × 1.000 | 10.5900 |
| Practice expense | 9.57 | × 0.940 | 8.9958 |
| Malpractice | 2.25 | × 0.898 | 2.0205 |
| Total RVUs | 21.6063 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Utah$721.67
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 10.59 | 1 |
| Practice expense | 9.57 | 0.94 |
| Malpractice | 2.25 | 0.898 |
(10.59 × 1 + 9.57 × 0.94 + 2.25 × 0.898) × $33.4009 = $721.67
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.
23155 billing questions
How is this different from 23150?
23155 describes humeral lesion removal or curettage with autograft. Use 23150 when the procedure is performed without a graft.
When would 23156 be used instead?
23156 is the related humeral lesion procedure when allograft is used. The operative report should identify the graft source.
Is the autograft part of this code?
Yes. Autograft use is the feature that distinguishes this code from the no-graft and allograft options in the humeral lesion group.
What documentation supports reporting 23155?
Document the humeral location, the bone cyst or benign tumor treated, the removal or curettage performed, and use of autograft to fill the defect.
How are bilateral cases and additional procedures handled?
Modifier 50 applies to bilateral procedures, with payment at 150%. For multiple procedures in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided; 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.
2,17223145,,Removal of bone lesion,A,,9.17,8.55,NA,8.55,,1.95,19.67,19.67,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,17323146,,Removal of bone lesion,A,,7.88,8.29,NA,8.29,,1.68,17.85,17.85,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,17423150,,Removal of humerus lesion,A,,8.69,8.40,NA,8.40,,1.85,18.94,18.94,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,17523155,,Removal of humerus lesion,A,,10.59,9.57,NA,9.57,,2.25,22.41,22.41,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,17623156,,Removal of humerus lesion,A,,8.88,8.46,NA,8.46,,1.90,19.24,19.24,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,17723170,,Sequestrectomy clavicle,A,,7.03,7.68,NA,7.68,,1.48,16.19,16.19,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,17823172,,Sequestrectomy scapula,A,,7.13,7.71,NA,7.71,,1.50,16.34,16.34,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985