CPT code 73000 – Clavicle X-ray

Key takeaways

CPT code 73000 bills a complete X-ray of the clavicle (collarbone), not the shoulder joint, the scapula or the AC joint.

Modifiers -26 and -TC split the claim when one party reads the images and another owns the equipment.

Medicare rates vary by MAC locality and change every year, so pull current figures from the CMS fee schedule lookup.

The most common denials come from weak medical necessity, a missing laterality modifier, or a missing distinct-service modifier when an NCCI edit applies.

CPT code 73000 covers a complete clavicle X-ray

CPT code 73000 is the code for a complete radiologic examination of the clavicle, as defined by the American Medical Association.

The official descriptor reads Radiologic examination; clavicle, complete. “Complete” means enough views for a full diagnostic read. In practice that’s usually an AP view plus a tilted or oblique projection, although the descriptor sets no fixed view count.

The code sits in the 73000-73225 range for upper-extremity radiology. Orthopedic practices, urgent care centers and hospital outpatient departments bill it most often. Emergency departments order it after falls and collisions, and orthopedic surgeons order it again to follow healing after fixation.

Where 73000 sits among its neighbors

What a 73000 study includes, and what it leaves out

CPT code 73000 covers the clavicle only. The shoulder joint, the scapula and the acromioclavicular (AC) joint as a standalone structure fall outside it, even when they show on the film.

If a provider orders a clavicle series and a shoulder series in the same encounter, both codes can be billed. Each one needs its own indication and documentation.

• Included: The AP view, plus lordotic, oblique or cephalic tilt views of the clavicle.
• Excluded: Separate AC joint stress views (73050), standalone shoulder imaging (73030) and scapula imaging (73010).
• Bilateral: Imaging both clavicles in one session takes modifier -50 or two line items with -LT and -RT. A second 73000 line without a laterality modifier will read as a duplicate.
• Chest films: When a chest X-ray (71046) happens to show the clavicle, don’t add 73000. The clavicle has to be the intended study, with its own clinical indication.

Medical necessity starts with a clavicle-specific reason

A 73000 claim needs a documented reason that points at the clavicle itself. Ordering a clavicle X-ray for general shoulder pain, with no clavicle-focused finding, is the quickest way to a payer denial.

These indications are commonly accepted:

• Suspected or confirmed clavicle fracture after trauma, such as a fall on an outstretched arm, a direct blow or a motor vehicle accident.
• AC joint separation, although AC stress views may call for 73050 rather than 73000 alone.
• Post-operative imaging after clavicle fixation surgery (ORIF).
• A suspected primary bone lesion, metastasis or osteomyelitis of the clavicle.
• A workers’ compensation injury involving direct clavicle trauma.
• Assessment of a congenital anomaly, such as cleidocranial dysostosis.

The ICD-10 codes that support a 73000 claim

Every 73000 claim needs an ICD-10-CM diagnosis code that establishes medical necessity. The table below lists the codes paired with it most often. For a less common diagnosis, search the full set of ICD-10-CM codes.

Local coverage determinations (LCDs) can differ by Medicare Administrative Contractor (MAC), so check the one for your jurisdiction.

Hardware follow-up is an easy row to get wrong. Clavicle plates and screws are bone implants rather than joint implants, so Z96.7 is the code to use. The fracture codes carry laterality in their sixth character. The side on the diagnosis should match the -LT or -RT on the CPT line.

Modifiers on 73000 follow who owns the equipment

Modifier choice is where 73000 claims go wrong most often. The right modifier depends on who owns the equipment and who reads the images, not only on where the patient was seen. A working grasp of medical billing compliance for split-service radiology helps before you attach anything to the code.

When to bill globally and when to split the claim

Global billing, with no modifier, applies when one provider or group owns the imaging equipment and employs the interpreting radiologist. A private orthopedic practice with its own X-ray unit and an on-site radiologist can bill this way. Once a second party touches the study, the claim splits, and the setting decides how.

In a hospital outpatient department, the hospital bills the technical service on its own facility claim, the UB-04. It’s paid under the Outpatient Prospective Payment System (OPPS). That line carries no -TC modifier. The interpreting physician then bills 73000-26 separately under the physician fee schedule.

The diagram below sets the three common arrangements side by side.

Medicare pays 73000 from the physician fee schedule

Medicare sets payment for 73000 each year under the Medicare Physician Fee Schedule (MPFS), adjusted by Geographic Practice Cost Index (GPCI) locality. The CMS Physician Fee Schedule lookup tool is the authoritative source for current rates. Pull figures from it for the payment year you’re billing, since printed tables go stale quickly.

Here’s how the rate structure fits together. Treat it as orientation, and confirm current amounts at CMS.

Workers’ compensation rates are set separately by each state. Texas, for instance, sets them through the Texas Department of Insurance, Division of Workers’ Compensation.

Don’t assume the Medicare rate applies to a workers’ compensation claim without payer confirmation. The FastRVU RVU lookup tool shows the current work, practice expense and malpractice RVUs for 73000 by locality.

The order decides between 73000, 73010, 73030 and 71046

Orthopedic and emergency coders regularly reach for 73030 when the study was a clavicle series, and the reverse happens too.

The choice turns on what the ordering provider meant to image, not on what shows up on the film. The AAPC Codify CPT lookup lets you compare full descriptors before you pick one.

The simplest rule is to bill what the order says. A “clavicle X-ray” order is 73000, and a “shoulder X-ray” order is 73030. When a chest X-ray was ordered and the clavicle simply appears on it, bill 71046 alone.

Here’s how that plays out on a busy shift. A cyclist lands on an outstretched left arm, and the ED orders “left clavicle, two views.” The coder bills 73000-LT with S42.002A.

If the order also asks for left shoulder views to rule out a shoulder injury, 73030-LT goes on the claim with its own indication. An NCCI check then decides whether a distinct-service modifier is needed.

Documentation that keeps a 73000 claim clean

A 73000 claim needs specific documentation before it reaches a payer. A missing element from the list below is the usual cause of a medical necessity denial. Good superbill documentation captures most of these fields at the point of service.

• Ordering provider: The name and NPI of the ordering clinician, which Medicare and most commercial payers require.
• Clinical indication: The specific reason for imaging the clavicle, tied to the ICD-10 code on the claim. “Shoulder pain” alone won’t support 73000, while “left clavicle fracture following fall” will.
• Number of views: The report must state how many projections were taken and name them. “Two views, AP and oblique” works, and “X-ray obtained” doesn’t.
• Signed interpretation: A written report with diagnostic findings, signed by the radiologist. A verbal read alone doesn’t meet the requirement.
• Laterality: Left, right or bilateral, matching the modifier on the claim.
• Prior authorization: Some commercial payers require it for outpatient radiology, even for plain films. Check the payer’s current policy before the study.

How a 73000 claim moves from order to payment

Each step below hands something to the next, and a weak handoff is where denials start.

1. Order: The clinician orders a clavicle study, names the side and records why.
2. Imaging: The technologist takes the views, and the report lists each projection.
3. Interpretation: The radiologist reads the films and signs a written report.
4. Coding: The coder assigns 73000, the laterality modifier, any -26 or -TC, and the most specific ICD-10 code.
5. Submission: Professional and global claims go out on the CMS-1500 (837P). A hospital’s technical claim goes on the UB-04 (837I).
6. Adjudication: The payer runs its edits, pays or denies the claim, and returns a remittance for posting.

Why 73000 claims get denied, and how to fix each one

Denials on 73000 trace back to six root causes. A denial management workflow that screens for them before submission stops most rejections before they turn into corrected claims or appeals.

• Unsupported medical necessity: The ICD-10 code doesn’t map to an accepted indication for clavicle imaging under the applicable LCD. Fix: check the diagnosis against the MAC’s LCD before you submit.
• Missing laterality modifier: Billing 73000 without -LT or -RT, when the payer expects laterality, triggers an automatic edit. Fix: make laterality a required field before the claim is created.
• Missing distinct-service modifier with 73030: If an NCCI edit applies to the pair, the second study can deny without one. Fix: check the current NCCI table and append -59 or the payer-preferred X modifier (such as XS) when needed. Document a separate indication for each study.
• Split-billing mismatch: A radiologist billing without -26, while the facility also bills, produces a duplicate-service denial. In a hospital outpatient department, the hospital’s technical service is paid under OPPS, and only the radiologist’s line carries -26. Fix: confirm billing arrangements with the facility first.
• Missing prior authorization: Some commercial payers require it for outpatient plain films. Fix: check the payer’s authorization rules when the study is scheduled.
• Duplicate billing: The same code, patient and date of service goes out twice, often from a rebilling workflow. Fix: run a duplicate check before every resubmission.

Before you submit: A quick 73000 checklist

Run these checks before a 73000 claim leaves the practice. Each one matches a denial above, and together they describe a clean claim for this code.

• The order names the clavicle, the side and a clavicle-specific reason.
• The diagnosis is coded to full specificity, such as S42.002A rather than a truncated S42.00.
• The diagnosis side matches the -LT or -RT on the CPT line.
• The report lists the views taken and carries the radiologist’s signature.
• You know who bills the technical part and who bills -26.
• Any same-day shoulder or scapula study has been checked against NCCI edits.
• Prior authorization is on file where the payer requires it.

How Pabau keeps CPT code 73000 claims complete

Plenty of 73000 rework starts when someone keys the claim by hand from the radiology report. One dropped laterality modifier or mistyped diagnosis is enough to send it back.

Pabau, the practice management platform we build, pre-fills the claim from the patient record instead. The CPT code attached to the service lands on the charge line, and the ICD-10 slots draw from the recorded problem list. Built-in ICD-10 and CPT lookup libraries let coders search for the exact code rather than typing it from memory.

Before the Send button unlocks, Pabau’s medical claims management checks that every required claim field is filled in. US claims then go out through Claim.MD, with real-time eligibility checks before the visit and ERA posting when the payer responds. Your billing team spends less time re-keying claims and more time on the ones that need judgment.

Cut the rework on clavicle X-ray claims

Pabau pre-fills each claim from the patient record and checks required fields before submission. US claims go out through Claim.MD, so your billing team spends less time re-keying.

Book a demo

Conclusion

Treat 73000 as the narrow code it is, and most of its trouble goes away. Bill it only when the order names the clavicle, and let the diagnosis show why the study was needed.

The bigger risk sits in the modifiers. Agree with the facility on who bills the technical and professional parts before the first claim goes out. Then check NCCI edits whenever 73000 shares a claim with a shoulder or scapula study. That ten-minute conversation costs far less than working a stack of duplicate-service denials.

If your team still rebuilds each claim from the radiology report, that’s where the time goes. Book a demo to see how Pabau pre-fills 73000 claims from the patient record and checks them before they’re sent.

Continue your research

Need to understand how clearinghouse validation works? Claim.MD clearinghouse overview explains how electronic claims are validated before reaching the payer.

Want to close the loop once a claim pays? Electronic remittance advice processing covers how ERA files and 835 transactions post payment for submitted claims.

Dealing with repeated claim rejections? Denial codes in medical billing breaks down CARC reason codes and how to act on each one.

Billing the upper arm on the same visit? CPT code 73060 covers humerus X-ray billing, views and modifiers.

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