{"id":183266,"date":"2026-08-18T08:35:21","date_gmt":"2026-08-18T08:35:21","guid":{"rendered":"https:\/\/pabau.com\/?p=183266"},"modified":"2026-08-18T08:35:24","modified_gmt":"2026-08-18T08:35:24","slug":"cpt-code-21700","status":"publish","type":"post","link":"https:\/\/pabau.com\/de\/procedure-codes\/cpt-code-21700\/","title":{"rendered":"CPT code 21700: Division of scalenus anticus, RVUs and billing"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT Code 21700: Division of Scalenus Anticus, RVU Values and Billing Guide\",\"description\":\"CPT code 21700 covers division of scalenus anticus without cervical rib resection. Find RVU values, Medicare reimbursement rates, ICD-10 pairings, and billing rules.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21700\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-08-08\",\"dateModified\":\"2026-08-18\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>CPT code 21700 covers surgical division of the scalenus anticus muscle without resection of the cervical rib.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>The work RVU is about 6.15, and the total RVU is roughly 9.95 under the current fee schedule.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>A 90-day global period bundles routine post-operative care into the surgical payment.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>CPT 21705 is the correct code whenever the operative report documents cervical rib resection.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Practice management software like Pabau tracks global periods and flags missing documentation before a claim goes out.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">CPT code 21700 is the procedure code for division of the scalenus anticus muscle without resection of the cervical rib. The surgeon cuts the anterior scalene to relieve compression in the thoracic outlet. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The official descriptor, maintained by the <a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt\/cpt-code-set-overview\" target=\"_blank\" rel=\"nofollow noopener\">American Medical Association (AMA)<\/a>, reads: <strong>Division of scalenus anticus; without resection of cervical rib.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The code sits in the Musculoskeletal System section of the CPT code set, which runs from 20000 to 29999. It carries a 90-day global period. Accurate <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">claims management<\/a> on a surgical code starts with reading that descriptor word by word.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-21700\/track-claims-from-start-to-finish.webp\" alt=\"Claims tracking dashboard in Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Pabau tracks each 21700 claim from submission to payment, so a denial surfaces while the appeal window is still open.<\/em><\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">The primary clinical indication is thoracic outlet syndrome (TOS) that has not responded to conservative management. Surgeons choose 21700 when the plan calls for muscle division alone, with the cervical rib left in place. That boundary is what separates it from the adjacent codes in the family.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Detail<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Value<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Official CPT descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Division of scalenus anticus; without resection of cervical rib<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code section<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Musculoskeletal System (CPT 20000-29999)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Primary clinical indication<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Thoracic outlet syndrome (TOS); conservative treatment failure<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Maintained by<\/td>\n<td style=\"padding:12px 16px;color:#374151\">American Medical Association (AMA) CPT Editorial Panel<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Global period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">090 (90 days)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"CPT Coding Pitfalls Every Medical Practice Faces\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/vbvV5okdXKg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 id=\"h-rvu-values-for-cpt-21700\" class=\"wp-block-heading\">RVU values for CPT 21700<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Relative Value Units (RVUs) decide how Medicare and many commercial payers price a surgical procedure. CPT code 21700 carries a work RVU of about 6.15. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Total RVU comes to roughly 9.95, and the facility and non-facility totals match, because the procedure is performed in a facility. Check the <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS Physician Fee Schedule lookup tool<\/a> for the active year before you bill.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">RVU component<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Facility setting<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Non-facility setting<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Work RVU (wRVU)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">6.15<\/td>\n<td style=\"padding:12px 16px;color:#374151\">6.15<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Practice expense (PE) RVU<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Priced by CMS for the facility setting<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Priced by CMS for the non-facility setting<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Malpractice RVU<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Included in the total<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Included in the total<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Total RVU<\/td>\n<td style=\"padding:12px 16px;color:#374151\">About 9.95<\/td>\n<td style=\"padding:12px 16px;color:#374151\">About 9.95<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">These figures come from the CMS Medicare Physician Fee Schedule and are rounded. CMS republishes the weights every year, so confirm the current-year values for 21700 before submitting. Practice expense RVUs are the component most likely to move between settings and between fee schedule years.<\/p>\n\n\n\n<h2 id=\"h-how-medicare-calculates-reimbursement\" class=\"wp-block-heading\">How Medicare calculates reimbursement<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare payment for CPT 21700 is the total RVU multiplied by the annual conversion factor. At a conversion factor of $33.40, a total RVU of 9.95 puts the unadjusted national payment near $332. The geographic adjustment for your locality then moves that number up or down.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practices billing in a hospital outpatient or ambulatory surgical center (ASC) setting receive the facility rate. An office-based setting would use the non-facility rate, which is rare for an open thoracic procedure. Rates reset every January 1, so pull the current figure rather than reusing last year&#8217;s.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Total RVU:<\/strong> About 9.95 for 21700, before any geographic adjustment<\/li>\n\n\n\n<li><strong>Conversion factor:<\/strong> Published by CMS each fall for the following calendar year<\/li>\n\n\n\n<li><strong>Geographic adjustment:<\/strong> GPCI values adjust work, practice expense, and malpractice by locality<\/li>\n\n\n\n<li><strong>Verification:<\/strong> Search code 21700 in the CMS tool using the current year and your locality<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Surgical teams tend to want the fee schedule inside the billing workflow rather than in a separate spreadsheet. The <a href=\"https:\/\/pabau.com\/industry\/plastic-surgery-emr\/\">plastic surgery EMR<\/a> guide walks through that setup for practices billing high-RVU procedures.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Verify CPT 21700 reimbursement each January, when CMS finalizes the fee schedule. Pull the locality-adjusted rate using your practice&#8217;s CMS locality code before you bill the first claim of the year. A rate carried over from last year causes underbilling or payer disputes that are expensive to unwind.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-the-90-day-global-period-and-post-operative-billing\" class=\"wp-block-heading\">The 90-day global period and post-operative billing<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT code 21700 carries a 90-day global period, designated &#8222;090&#8220; in the fee schedule. Medicare and most commercial payers bundle routine post-operative services into the surgical payment for those 90 days. Billing a typical follow-up visit inside that window without a valid modifier will be denied.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The bundle covers pre-operative evaluation on the day before or day of surgery, the procedure itself, and routine post-operative management through day 90. Services outside the bundle can still be billed with the right documentation and modifier.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Included in the global bundle:<\/strong> Routine post-op visits, wound checks, and standard follow-up related to the procedure<\/li>\n\n\n\n<li><strong>Separately billable:<\/strong> Treatment of a new, unrelated condition (append modifier -24 to the E\/M code)<\/li>\n\n\n\n<li><strong>Separately billable:<\/strong> Staged or planned additional procedures (modifier -58)<\/li>\n\n\n\n<li><strong>Separately billable:<\/strong> Unplanned return to the operating room for a related problem (modifier -78)<\/li>\n\n\n\n<li><strong>Separately billable:<\/strong> An unrelated procedure or service by the same physician during the post-operative period (modifier -79)<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Tracking the 90-day window across a full surgical panel is where billing errors accumulate. High-volume practices use <a href=\"https:\/\/pabau.com\/features\/automated-workflows-software\/\">automated workflows<\/a> to flag the date a global period expires. Missing that date can also push a corrected claim past the payer&#8217;s <a href=\"https:\/\/pabau.com\/blog\/timely-filing-limits\/\">timely filing limits<\/a>.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-21700\/automated-communication-in-pabau.webp\" alt=\"Automated patient communication settings in Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Automated post-op messages in Pabau go out on schedule through the 90-day global period, and every send is logged against the record.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 id=\"h-icd-10-diagnosis-codes-that-support-the-claim\" class=\"wp-block-heading\">ICD-10 diagnosis codes that support the claim<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Linking CPT code 21700 to the right ICD-10-CM diagnosis is what establishes medical necessity with the payer. The diagnosis has to reflect the documented condition that led to surgery. Two families of codes carry this procedure when thoracic outlet syndrome is the indication.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10-CM code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to use<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G54.0<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Brachial plexus disorders<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Neurogenic TOS and scalenus anticus syndrome, both of which the ICD-10-CM index maps here<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M75.80, M75.81, M75.82<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Other shoulder lesions, unspecified, right, or left shoulder<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Shoulder-region presentation without documented neurogenic TOS; M75.8 alone is not billable, so pick the laterality subcode<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Payers may require the diagnosis to appear in their local coverage determination (LCD) for thoracic outlet procedures. Verify the pairing with the <a href=\"https:\/\/www.aapc.com\/codify\/icd-10-crosswalk.aspx\" target=\"_blank\" rel=\"nofollow noopener\">AAPC crosswalk<\/a> before submitting. Character-level detail decides whether a musculoskeletal code is billable at all, and the shoulder fracture code <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s42463g\/\">S42.463G<\/a> shows the same rule at work.<\/p>\n\n\n\n<h2 id=\"h-cpt-21700-vs-cpt-21705\" class=\"wp-block-heading\">CPT 21700 vs CPT 21705<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The most frequent miscoding error in thoracic outlet surgery is billing 21700 when the operative report documents cervical rib resection. That procedure belongs to CPT 21705. The difference is procedural scope, and the RVU spread is wide enough that auditors flag the pairing regularly.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Descriptor<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Cervical rib resection?<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Key differentiator<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21700<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Division of scalenus anticus; without resection of cervical rib<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Muscle division only; lower wRVU<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21705<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Division of scalenus anticus; with resection of cervical rib<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Muscle division plus rib removal; higher wRVU<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The operative note is the determining document. If the surgeon performed and documented cervical rib resection, 21705 is the correct code, even when the original plan said otherwise. Billing 21705 without documented rib resection is upcoding. Billing 21700 when the rib came out leaves earned reimbursement behind.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Billing staff handling thoracic outlet procedures should read the operative report against the selected code before submission. The same descriptor-level review governs neighboring musculoskeletal codes such as <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-20103\/\">CPT 20103<\/a>.<\/p>\n\n\n\n<h2 id=\"h-related-thoracic-outlet-cpt-codes\" class=\"wp-block-heading\">Related thoracic outlet CPT codes<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Thoracic outlet procedures span several CPT codes, depending on the surgical approach and the structures addressed. Choosing correctly means reading the operative note for each element performed. The table below covers the codes most likely to appear alongside or instead of 21700.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Descriptor<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to use<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21700<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Division of scalenus anticus; without resection of cervical rib<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Muscle division only; no rib addressed<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21705<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Division of scalenus anticus; with resection of cervical rib<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Muscle division plus cervical rib removal<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21615<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Excision first and\/or cervical rib<\/td>\n<td style=\"padding:12px 16px;color:#374151\">First or cervical rib resection for vascular or venous TOS<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21616<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Excision first and\/or cervical rib; with sympathectomy<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Rib resection combined with cervical sympathectomy<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Vascular TOS, where the subclavian artery or vein is compressed, usually leads to first rib resection under 21615 or 21616. Neurogenic TOS with brachial plexus compression more often lands on 21700 or 21705. The documented neurovascular findings and the pre-operative imaging drive the choice.<\/p>\n\n\n\n<h2 id=\"h-modifiers-that-apply-to-this-procedure\" class=\"wp-block-heading\">Modifiers that apply to this procedure<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Modifiers tell the payer that something about the procedure or the billing circumstance was different. Several apply to CPT 21700 in specific clinical situations. Using the wrong one, or leaving out a required one, is a common denial trigger on surgical claims.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Name<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to apply<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-22<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Increased procedural services<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Documented complexity, such as severe scarring or atypical anatomy, that adds substantial time or effort<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-51<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Multiple procedures<\/td>\n<td style=\"padding:12px 16px;color:#374151\">21700 performed with another procedure in the same session; append to the secondary procedure<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-62<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Two surgeons<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Co-surgery requiring two surgeons with distinct skills; each surgeon bills with -62<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-80<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Assistant surgeon<\/td>\n<td style=\"padding:12px 16px;color:#374151\">An assistant surgeon is required and documented; the assistant bills at a reduced rate<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Payer-specific modifier rules can differ from Medicare defaults. Review the payer&#8217;s modifier policy, or check with a certified coder, before appending anything to a 21700 claim. When one comes back rejected, the remittance <a href=\"https:\/\/pabau.com\/blog\/denial-codes-in-medical-billing\/\">denial codes<\/a> usually name the modifier at fault.<\/p>\n\n\n\n<h2 id=\"h-documentation-payers-expect-to-see\" class=\"wp-block-heading\">Documentation payers expect to see<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A denied 21700 claim almost always traces back to documentation that doesn&#8217;t support the procedure billed. Payers want specific operative and pre-operative records before they pay. The checklist below covers the elements audits of thoracic outlet claims flag most often.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Operative report:<\/strong> Names the muscle divided, confirms no cervical rib was resected, and describes the approach and technique<\/li>\n\n\n\n<li><strong>Medical necessity:<\/strong> Pre-operative notes showing failed conservative treatment across an adequate trial period<\/li>\n\n\n\n<li><strong>Diagnosis documentation:<\/strong> Clinical notes that support the ICD-10-CM code selected, such as neurogenic TOS for G54.0<\/li>\n\n\n\n<li><strong>Imaging or EMG\/NCS findings:<\/strong> Diagnostic studies supporting the surgical indication, referenced in the operative or pre-op note<\/li>\n\n\n\n<li><strong>Informed consent:<\/strong> Signed consent naming the specific procedure performed<\/li>\n\n\n\n<li><strong>Post-operative note:<\/strong> Confirms the completed procedure and matches the code billed<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The operative report is the single most important document here. If it reads &#8222;division of the anterior scalene muscle&#8220; without addressing the cervical rib, the coder queries the surgeon before submitting. What happened in the operating room is not something a coder can assume.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau&#8217;s <a href=\"https:\/\/pabau.com\/features\/patient-intake-software\/\">digital forms<\/a> let a practice standardize pre-operative and post-operative capture, so the record supports the code by default. That consistency is most of what separates a queried claim from a <a href=\"https:\/\/pabau.com\/blog\/clean-claim\/\">clean claim<\/a> on the first pass.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-21700\/digital-forms.webp\" alt=\"Digital consent and intake form builder in Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s digital forms capture consent and pre-operative findings in a fixed structure, so the record already holds what a 21700 audit asks for.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 id=\"h-payer-policies-and-prior-authorization\" class=\"wp-block-heading\">Payer policies and prior authorization<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Coverage of CPT 21700 turns on whether the documentation meets the payer&#8217;s medical necessity criteria for thoracic outlet syndrome. Many commercial payers publish policies that go well beyond the standard ICD-10 crosswalk. They set out how long conservative treatment must run before surgery is authorized.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Descriptors and RVU tables are easy to look up. Authorization rules are where a 21700 claim is usually won or lost, so billing staff should check four things before the procedure is scheduled.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Prior authorization requirement:<\/strong> Many commercial payers require pre-authorization for thoracic outlet surgery. Check the plan&#8217;s rules before the procedure, not after<\/li>\n\n\n\n<li><strong>Conservative treatment threshold:<\/strong> Most payers want 6-12 weeks of documented physical therapy and conservative management first. The exact threshold varies by plan<\/li>\n\n\n\n<li><strong>LCD or NCD applicability:<\/strong> Check whether a local coverage determination applies in your Medicare Administrative Contractor (MAC) region. An LCD can restrict covered diagnoses or add requirements<\/li>\n\n\n\n<li><strong>Bilateral procedures:<\/strong> If both sides are addressed, bilateral indicator rules apply. Confirm with the payer rather than assuming the claim will process<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Conservative care usually runs through physical therapy, and those notes are the first thing a reviewer reads. Practices on <a href=\"https:\/\/pabau.com\/industry\/sports-medicine-software\/\">sports medicine software<\/a> can pull that therapy history straight into the authorization request. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Running <a href=\"https:\/\/pabau.com\/blog\/insurance-eligibility-verification\/\">eligibility verification<\/a> before the surgery date closes the other common pre-service denial.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Build a prior authorization checklist for CPT 21700 and your top three commercial payers. List the documentation each one requires, the submission window relative to the procedure date, and the appeal deadline if the request is denied. A standard checklist cuts turnaround time and heads off the most common pre-procedure denial.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-how-claims-management-software-keeps-21700-claims-clean\" class=\"wp-block-heading\">How claims management software keeps 21700 claims clean<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most surgical practices track global periods in a spreadsheet, or in someone&#8217;s head. The 90-day window on CPT 21700 opens on the day of surgery. Every post-op visit inside it has to be checked against the bundle before anyone bills it. That check is easy to skip when the schedule is full.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau keeps that window on the client record itself. The operative note, the consent form, and the post-op documentation sit with the appointment that generated the claim. Billing staff can see which modifier a visit needs without reopening the chart in a second system.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The payoff is fewer denials on the codes that carry the most revenue. Your coders spend their time on the claims that genuinely need a query, and the rest go out first time. The wider workflow is covered in the <a href=\"https:\/\/pabau.com\/blog\/practice-management-software\/\">practice management software<\/a> guide.<\/p>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Keep surgical claims clean from the first submission                <\/h3>\n\n                <p class=\"description\">\n                    Pabau helps surgical practices track 90-day global periods, apply the right modifiers, and catch missing documentation before a claim reaches the payer. See the billing workflow in a live demo.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau practice management dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The operative note decides this code, not the surgical plan. If the surgeon documented cervical rib resection, the claim is 21705, whatever the schedule said that morning. Coders who query before submitting almost never see this denial.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The reimbursement follows from that discipline. A work RVU of 6.15 is worth defending with a clean operative report, a supported diagnosis, and an authorization on file. Those three take minutes to line up beforehand and hours to fix afterward.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Prior authorization is the piece worth building a process around, because it is the only one you cannot repair after the fact. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how Pabau tracks global periods and surgical documentation for billing teams.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Want the compliance rules behind surgical coding?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/medical-billing-compliance\/\">Medical billing compliance<\/a> sets out the audit standards that decide whether documentation holds up.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need the wider picture on getting paid?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/what-is-revenue-cycle-management\/\">Revenue cycle management<\/a> walks through each stage from scheduling to final payment posting.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Working through a backlog of rejected claims?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/denial-management-in-healthcare\/\">Denial management in healthcare<\/a> covers how to triage denials and build appeals that succeed.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Trying to reconcile what the payer actually paid?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/electronic-remittance-advice\/\">Electronic remittance advice<\/a> explains how to read the remittance file and post payments accurately.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1786974832023\"><h3 class=\"schema-faq-question\">What does CPT code 21700 describe?<\/h3> <p class=\"schema-faq-answer\">CPT code 21700 describes surgical division of the scalenus anticus (anterior scalene) muscle without resection of the cervical rib. It is used mainly for thoracic outlet syndrome after conservative treatment has failed. The surgeon must determine that muscle division alone is the indicated procedure.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786974832024\"><h3 class=\"schema-faq-question\">What is the RVU value for CPT 21700?<\/h3> <p class=\"schema-faq-answer\">The work RVU for CPT 21700 is about 6.15, and the total RVU is roughly 9.95, based on CMS Medicare Physician Fee Schedule data. The total includes the practice expense and malpractice components. CMS updates these weights annually, so verify the current-year figures in the CMS lookup tool before billing.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786974832025\"><h3 class=\"schema-faq-question\">What is the global period for CPT code 21700?<\/h3> <p class=\"schema-faq-answer\">CPT 21700 carries a 90-day global period, designated &#8222;090&#8220;. Routine post-operative services inside that window are bundled into the surgical payment. Anything billed separately during the global period needs the right modifier (-24, -58, -78, or -79, depending on the situation) and supporting documentation.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786974832026\"><h3 class=\"schema-faq-question\">What is the difference between CPT 21700 and CPT 21705?<\/h3> <p class=\"schema-faq-answer\">CPT 21700 covers scalene muscle division without cervical rib resection, while CPT 21705 covers the same division with the cervical rib removed. The operative report determines which applies. Billing 21700 when the rib was resected can trigger audit recovery, and billing 21705 without documented resection is upcoding.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786974832027\"><h3 class=\"schema-faq-question\">What modifiers can be used with CPT 21700?<\/h3> <p class=\"schema-faq-answer\">Common modifiers for CPT 21700 are -22 for documented increased complexity and -51 for multiple procedures in one session. Co-surgery is billed with -62, and an assistant surgeon with -80. Applicability varies by payer. Always check the individual payer&#8217;s modifier policy before appending one to the claim.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786974832028\"><h3 class=\"schema-faq-question\">Does CPT 21700 require prior authorization?<\/h3> <p class=\"schema-faq-answer\">Prior authorization requirements vary by payer and plan. Most commercial payers require pre-authorization for thoracic outlet surgery, plus documentation of failed conservative treatment, typically 6-12 weeks of physical therapy. Medicare requirements depend on the local coverage determination for your MAC region, so verify before scheduling.<\/p> <\/div> <\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>CPT 21700 covers scalene division without cervical rib resection. Work RVU 6.15, a 90-day global period, and the ICD-10 codes payers accept.<\/p>\n","protected":false},"author":83,"featured_media":183263,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"83","_yoast_wpseo_content_score":"30","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1546],"tags":[],"class_list":["post-183266","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-cpt-codes"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>CPT Code 21700: Division of Scalenus Anticus, RVUs and Billing<\/title>\n<meta name=\"description\" content=\"Understand CPT code 21700: the procedure for 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The surgeon must determine that muscle division alone is the indicated procedure.\",\"inLanguage\":\"de\"},\"inLanguage\":\"de\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/cpt-code-21700\\\/#faq-question-1786974832024\",\"position\":2,\"url\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/cpt-code-21700\\\/#faq-question-1786974832024\",\"name\":\"What is the RVU value for CPT 21700?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"The work RVU for CPT 21700 is about 6.15, and the total RVU is roughly 9.95, based on CMS Medicare Physician Fee Schedule data. The total includes the practice expense and malpractice components. CMS updates these weights annually, so verify the current-year figures in the CMS lookup tool before billing.\",\"inLanguage\":\"de\"},\"inLanguage\":\"de\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/cpt-code-21700\\\/#faq-question-1786974832025\",\"position\":3,\"url\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/cpt-code-21700\\\/#faq-question-1786974832025\",\"name\":\"What is the global period for CPT code 21700?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT 21700 carries a 90-day global period, designated \\\"090\\\". Routine post-operative services inside that window are bundled into the surgical payment. Anything billed separately during the global period needs the right modifier (-24, -58, -78, or -79, depending on the situation) and supporting documentation.\",\"inLanguage\":\"de\"},\"inLanguage\":\"de\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/cpt-code-21700\\\/#faq-question-1786974832026\",\"position\":4,\"url\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/cpt-code-21700\\\/#faq-question-1786974832026\",\"name\":\"What is the difference between CPT 21700 and CPT 21705?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT 21700 covers scalene muscle division without cervical rib resection, while CPT 21705 covers the same division with the cervical rib removed. The operative report determines which applies. Billing 21700 when the rib was resected can trigger audit recovery, and billing 21705 without documented resection is upcoding.\",\"inLanguage\":\"de\"},\"inLanguage\":\"de\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/cpt-code-21700\\\/#faq-question-1786974832027\",\"position\":5,\"url\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/cpt-code-21700\\\/#faq-question-1786974832027\",\"name\":\"What modifiers can be used with CPT 21700?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Common modifiers for CPT 21700 are -22 for documented increased complexity and -51 for multiple procedures in one session. Co-surgery is billed with -62, and an assistant surgeon with -80. Applicability varies by payer. 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She enjoys breaking down complex topics into clear, accessible content and has a soft spot for the often-overlooked aspects of clinic life. When she's not writing, she's exploring cafes, walking her dog, or spending time with friends and family.","url":"https:\/\/pabau.com\/de\/blog\/author\/anja-dodevska\/"},{"@type":"Question","@id":"https:\/\/pabau.com\/de\/procedure-codes\/cpt-code-21700\/#faq-question-1786974832023","position":1,"url":"https:\/\/pabau.com\/de\/procedure-codes\/cpt-code-21700\/#faq-question-1786974832023","name":"What does CPT code 21700 describe?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT code 21700 describes surgical division of the scalenus anticus (anterior scalene) muscle without resection of the cervical rib. It is used mainly for thoracic outlet syndrome after conservative treatment has failed. The surgeon must determine that muscle division alone is the indicated procedure.","inLanguage":"de"},"inLanguage":"de"},{"@type":"Question","@id":"https:\/\/pabau.com\/de\/procedure-codes\/cpt-code-21700\/#faq-question-1786974832024","position":2,"url":"https:\/\/pabau.com\/de\/procedure-codes\/cpt-code-21700\/#faq-question-1786974832024","name":"What is the RVU value for CPT 21700?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"The work RVU for CPT 21700 is about 6.15, and the total RVU is roughly 9.95, based on CMS Medicare Physician Fee Schedule data. The total includes the practice expense and malpractice components. CMS updates these weights annually, so verify the current-year figures in the CMS lookup tool before billing.","inLanguage":"de"},"inLanguage":"de"},{"@type":"Question","@id":"https:\/\/pabau.com\/de\/procedure-codes\/cpt-code-21700\/#faq-question-1786974832025","position":3,"url":"https:\/\/pabau.com\/de\/procedure-codes\/cpt-code-21700\/#faq-question-1786974832025","name":"What is the global period for CPT code 21700?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT 21700 carries a 90-day global period, designated \"090\". Routine post-operative services inside that window are bundled into the surgical payment. Anything billed separately during the global period needs the right modifier (-24, -58, -78, or -79, depending on the situation) and supporting documentation.","inLanguage":"de"},"inLanguage":"de"},{"@type":"Question","@id":"https:\/\/pabau.com\/de\/procedure-codes\/cpt-code-21700\/#faq-question-1786974832026","position":4,"url":"https:\/\/pabau.com\/de\/procedure-codes\/cpt-code-21700\/#faq-question-1786974832026","name":"What is the difference between CPT 21700 and CPT 21705?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT 21700 covers scalene muscle division without cervical rib resection, while CPT 21705 covers the same division with the cervical rib removed. The operative report determines which applies. Billing 21700 when the rib was resected can trigger audit recovery, and billing 21705 without documented resection is upcoding.","inLanguage":"de"},"inLanguage":"de"},{"@type":"Question","@id":"https:\/\/pabau.com\/de\/procedure-codes\/cpt-code-21700\/#faq-question-1786974832027","position":5,"url":"https:\/\/pabau.com\/de\/procedure-codes\/cpt-code-21700\/#faq-question-1786974832027","name":"What modifiers can be used with CPT 21700?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Common modifiers for CPT 21700 are -22 for documented increased complexity and -51 for multiple procedures in one session. Co-surgery is billed with -62, and an assistant surgeon with -80. Applicability varies by payer. Always check the individual payer's modifier policy before appending one to the claim.","inLanguage":"de"},"inLanguage":"de"},{"@type":"Question","@id":"https:\/\/pabau.com\/de\/procedure-codes\/cpt-code-21700\/#faq-question-1786974832028","position":6,"url":"https:\/\/pabau.com\/de\/procedure-codes\/cpt-code-21700\/#faq-question-1786974832028","name":"Does CPT 21700 require prior authorization?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Prior authorization requirements vary by payer and plan. Most commercial payers require pre-authorization for thoracic outlet surgery, plus documentation of failed conservative treatment, typically 6-12 weeks of physical therapy. Medicare requirements depend on the local coverage determination for your MAC region, so verify before scheduling.","inLanguage":"de"},"inLanguage":"de"}]}},"yoast":{"focus_keyword":"CPT code 21700","seo_title":"CPT Code 21700: Division of Scalenus Anticus, RVUs and Billing","meta_description":"Understand CPT code 21700: the procedure for division of the scalenus anticus muscle and its importance in claims management.","content_score":"30","is_cornerstone":"","related_keyphrases":[{"keyword":"thoracic outlet surgery CPT code","score":56},{"keyword":"CPT 21700 RVU","score":61},{"keyword":"CPT 21700 global period","score":61}]},"_links":{"self":[{"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/posts\/183266","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/users\/83"}],"replies":[{"embeddable":true,"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/comments?post=183266"}],"version-history":[{"count":3,"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/posts\/183266\/revisions"}],"predecessor-version":[{"id":183518,"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/posts\/183266\/revisions\/183518"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/media\/183263"}],"wp:attachment":[{"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/media?parent=183266"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/categories?post=183266"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/tags?post=183266"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}