CPT 23035Surgery

Drain shoulder bone lesion

CPT code 23035 covers a surgical procedure to drain fluid or infected material from a bone lesion in the shoulder area, typically the humerus (upper arm bone) or scapula (shoulder blade).

Showing rates for

National Average

Base Medicare rate

$675.39

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

9.16

PE RVU (NF)

9.83

MP RVU

1.89

Total RVU

20.88

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

NCCI bundling edits

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Billing tips

Always append laterality modifiers (LT or RT) even though not explicitly required by CPT; many Medicare MACs and commercial payers auto-deny without them
Impact: Prevents initial denial and 30-45 day payment delay on $675.39 claim
Document the specific bone involved (humerus, scapula, clavicle) and depth of lesion; superficial soft tissue drainage codes (10060-10061) pay only $100-200 and are commonly confused
Impact: Prevents downcoding from $675.39 to $116-232, protecting $459-543 in revenue
If irrigation and debridement of surrounding bone is performed beyond simple drainage, consider 23035 plus 23184 (bone cyst/benign tumor excision) with modifier 59 if documented as distinct procedures
Impact: Can increase total reimbursement by $600-900 when clinically appropriate and properly documented
Verify pre-authorization requirements for commercial payers; many require prior auth for shoulder bone procedures even when emergent drainage is medically necessary
Impact: Prevents 100% denial; retrospective emergency auth typically approved within 72 hours
Code cultures separately (87070-87077) and imaging guidance if used (76942 for ultrasound, 77002 for fluoro); these are not bundled into 23035
Impact: Additional $50-150 in legitimate ancillary revenue per case
When performed in facility setting, ensure facility also codes 23035 on UB-04; physician and facility both receive $675.39 as rates are identical for this code
Impact: Prevents facility revenue loss; physician payment unaffected by facility billing

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23035 in 2025?

The 2025 Medicare national average reimbursement for CPT 23035 is $675.39 for both facility and non-facility settings. This is based on 20.88 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality.

How many RVUs is CPT code 23035 worth?

CPT 23035 has 20.88 total RVUs in 2025, broken down as 9.16 work RVUs, 9.83 practice expense RVUs (both facility and non-facility), and 1.89 malpractice RVUs. This is a moderately valued surgical procedure code.

What is the difference between CPT 23035 and CPT 10060?

CPT 23035 is for drainage of a bone lesion in the shoulder requiring surgical access to the bone itself, while CPT 10060 is for simple incision and drainage of a skin abscess. Code 23035 requires documentation of bone involvement, drilling or trephination, and reimburses at $675.39 compared to approximately $116 for 10060.

Does CPT 23035 require a modifier for left or right shoulder?

While CPT guidelines don't explicitly mandate laterality modifiers for 23035, most Medicare MACs and commercial payers require modifiers LT (left) or RT (right) for proper claim processing. Failure to include laterality modifiers commonly results in denials or payment delays.

Can CPT 23035 be billed with shoulder arthroscopy codes?

Yes, CPT 23035 can be billed with shoulder arthroscopy codes (29805-29828) when procedures are performed at distinct anatomic sites or serve different purposes. Append modifier 59 to 23035 and ensure documentation clearly shows the bone lesion drainage was separate from arthroscopic work. NCCI edits do not automatically bundle these codes.

What diagnosis codes support medical necessity for CPT 23035?

Common supporting diagnosis codes include M86.011-M86.019 (acute hematogenous osteomyelitis of shoulder), M86.111-M86.119 (other acute osteomyelitis of shoulder), M85.40-M85.419 (solitary bone cyst of shoulder), and S42.201A-S42.92XA (shoulder fractures with complicating infection). Pre-operative imaging and clinical infection signs must support the diagnosis.

Is CPT 23035 an inpatient or outpatient procedure?

CPT 23035 can be performed in either inpatient or outpatient settings depending on patient acuity and infection severity. The 2025 Medicare payment is identical ($675.39) regardless of setting. Severe osteomyelitis cases requiring IV antibiotics typically occur inpatient, while contained bone cysts may be drained outpatient.