Billing code 23195: Humeral head resectionMedicare rate & RVUs in Utah
Reports surgical removal of the humeral head, typically when destructive disease or infection requires excision rather than head-preserving treatment.
CMS doesn’t publish an office rate for 23195 in Utah.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 23195 covers
An orthopedic surgeon removes the humeral head during an operative procedure, usually in a hospital or ambulatory surgery setting. The procedure may be performed for destructive disease or infection involving the head; the operative report should establish that the humeral head itself was resected, rather than only opening the shoulder joint or removing a limited bone lesion.
Select this code when the documented work is resection of the humeral head, and describe the anatomy removed and the clinical reason. The 90-day global period includes 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. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeons require 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.
23195 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $684.41 |
How the 23195 rate is calculated
Each of 23195’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 · 23195
RVUs × geographic indexes × conversion factor
Work10.10
10.10 RVUs× 1.000 GPCI
Practice expense9.00
9.00 RVUs× 1.000 GPCI
Malpractice2.15
2.15 RVUs× 1.000 GPCI
Adjusted RVUs
21.2500
Conversion factor
$33.4009
Medicare rate
$709.77
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 23195
23195 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 23195
Humeral head resection
| 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 · 23195
Humeral head resection
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
23195 without 50 · national facility
$709.77
Humeral head resection
23195-50 · Bilateral: 150%
$1,064.66
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).
23195 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 23184Bone excision
- 23195 is for resection of the humeral head. Use 23184 when the documented work is partial excision of bone in the proximal humerus.
- 23174Sequestrectomy
- 23174 describes removal of a sequestrum from the humeral head or surgical neck. Choose 23195 when the procedure is resection of the humeral head, not sequestrum removal alone.
- 23470Shoulder arthroplasty
- 23470 describes shoulder hemiarthroplasty, a reconstructive joint procedure. Code 23195 describes resection of the humeral head without identifying that arthroplasty service.
23195 billing questions
How is this different from partial excision of the proximal humerus?
Use 23195 when the humeral head is resected. Code 23184 describes partial excision of bone in the proximal humerus, so the operative report should support the specific extent removed.
Can this code be used for removal of a humeral sequestrum?
When the documented procedure is removal of a sequestrum from the humeral head or surgical neck, compare 23174. Code 23195 represents resection of the humeral head, not sequestrum removal alone.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How should bilateral resection be reported?
For a bilateral procedure, report modifier 50; CMS payment is at 150%.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only with supporting documentation, and 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 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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