CPT 23031Surgery

Drain shoulder bursa

CPT code 23031 covers the drainage of a shoulder bursa, which is a fluid-filled sac that cushions the shoulder joint. When this sac becomes inflamed and fills with excess fluid, a physician uses a needle to remove the fluid and relieve pressure.

Showing rates for

National Average

Base Medicare rate

$418.24

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

2.79

PE RVU (NF)

9.56

MP RVU

0.58

Total RVU

12.93

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Bill in non-facility setting whenever possible to maximize reimbursement
Impact: Non-facility rate is $418.24 vs facility rate of $221.57—a difference of $196.67 (89% higher reimbursement)
Document ultrasound guidance separately if used for needle placement
Impact: CPT 76942 (ultrasound guidance) can be billed separately and adds approximately $70-90 to total reimbursement when medically necessary
Always append LT or RT modifier to specify laterality
Impact: Prevents automatic denials and processing delays; many payers will reject claims without laterality modifiers on shoulder procedures
Send fluid for culture/analysis and document in operative note when clinically indicated
Impact: Supports medical necessity and may justify additional laboratory billing codes (87070-87077 for cultures); strengthens appeal if denied
Do not bill 23031 with shoulder arthroscopy codes (29805-29828) for the same bursa
Impact: Considered bundled/incidental to arthroscopy; billing separately may result in denial and potential fraud investigation
For repeat drainage within global period, document why it was medically necessary and unplanned
Impact: Without proper documentation of complication or new condition, repeat drainage may be denied as included in original procedure's global fee

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23031 in 2025?

The 2025 Medicare national average reimbursement for CPT 23031 is $418.24 in a non-facility setting and $221.57 in a facility setting. These rates are based on a total RVU of 12.93 (non-facility) and the 2025 conversion factor of 32.3465.

Can CPT 23031 be billed with an office visit on the same day?

Yes, CPT 23031 can be billed with an E/M service on the same day if you append modifier 25 to the E/M code. The documentation must clearly show the E/M service was significant and separately identifiable from the usual pre- and post-procedure work associated with the bursa drainage.

What is the difference between CPT 23031 and CPT 20610?

CPT 23031 is specifically for drainage/aspiration of a shoulder bursa, while CPT 20610 is for aspiration and/or injection of a major joint or bursa (not specifically shoulder). Code 23031 should be used when draining a shoulder bursa, as it is more anatomically specific and has different reimbursement rates.

How many work RVUs is CPT 23031 worth?

CPT 23031 has a work RVU value of 2.79 for 2025. The total RVU is 12.93, which includes 9.56 practice expense RVUs (non-facility), 3.48 practice expense RVUs (facility), and 0.58 malpractice RVUs.

Do I need imaging confirmation before billing CPT 23031?

While imaging confirmation (ultrasound or MRI showing bursal effusion) is not absolutely required, it significantly strengthens medical necessity documentation and reduces denial risk. Clinical examination showing a palpable fluid collection with appropriate signs and symptoms may be sufficient, but imaging is recommended when diagnosis is uncertain.

Can CPT 23031 be billed bilaterally?

Yes, if bilateral shoulder bursa drainage is performed during the same session, bill CPT 23031 with modifier 50 (bilateral procedure). Documentation must support medical necessity for draining both shoulders. Reimbursement is typically 150% of the unilateral rate, though this varies by payer.

Is ultrasound guidance included in CPT 23031?

No, ultrasound guidance is not included in CPT 23031. If ultrasound is used for real-time needle guidance during the aspiration, you may separately bill CPT 76942 (ultrasonic guidance for needle placement) when medically necessary and documented. This can add approximately $70-90 to the reimbursement.