CPT 23044Surgery

Exploratory shoulder surgery

CPT 23044 covers exploratory shoulder surgery, where a surgeon opens the shoulder joint to investigate pain, damage, or other conditions that couldn't be diagnosed through imaging alone. This is a diagnostic procedure used when less invasive methods haven't provided enough information.

Showing rates for

National Average

Base Medicare rate

$556.68

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

7.59

PE RVU (NF)

8.01

MP RVU

1.61

Total RVU

17.21

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

NCCI bundling edits

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Billing tips

Document why arthroscopy was not performed or was inadequate before billing 23044
Impact: Prevents medical necessity denials which account for 40% of exploratory procedure claim rejections
Verify whether a definitive procedure was performed during the same session; if so, 23044 may bundle
Impact: Exploratory codes often bundle into definitive repairs; unbundling inappropriately risks $556.68 recoupment
Include detailed operative findings in documentation even if no corrective action taken
Impact: Comprehensive findings documentation reduces appeal time by 60% and supports medical necessity for future definitive procedures
Use modifier 22 with clear documentation when extensive lysis of adhesions or scar tissue removal is required
Impact: Can increase reimbursement by $111-278 when properly documented with time and complexity details
Bill same-day facility and professional components separately; verify global period ended before billing related E/M
Impact: 10-day global period applies; E/M services within global period without modifier 24 will deny, losing $100-200 per visit
Append modifier 59 when performing exploratory surgery at different anatomic site from another shoulder procedure
Impact: Prevents CCI edit denials that would result in complete denial of the $556.68 payment

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23044 in 2025?

Medicare pays $556.68 for CPT 23044 in 2025 for both facility and non-facility settings, based on the national average rate. This is calculated using the total RVU of 17.21 multiplied by the 2025 conversion factor of 32.3465. Local rates may vary based on geographic practice cost indices.

Does CPT 23044 bundle with arthroscopic shoulder procedures?

Yes, 23044 typically bundles with definitive shoulder procedures performed during the same operative session. If a surgeon begins with open exploration and then performs a repair, only the definitive repair code is billable. The exploratory component is considered included unless performed at a completely separate anatomic site or through a distinct surgical approach, which would require modifier 59.

When is open shoulder exploration justified instead of arthroscopy?

Open exploration (23044) is justified when arthroscopy is contraindicated due to infection risk, failed previous arthroscopic visualization, severe adhesions preventing arthroscopic access, complex trauma requiring direct palpation, or when patient anatomy prevents adequate arthroscopic positioning. Documentation must clearly explain why arthroscopy was not appropriate.

What RVU values are assigned to CPT 23044?

CPT 23044 has a total RVU of 17.21 for 2025, consisting of 7.59 work RVUs, 8.01 practice expense RVUs (both facility and non-facility), and 1.61 malpractice RVUs. These relatively high RVU values reflect the surgical complexity and risks associated with open shoulder exploration.

Can CPT 23044 be billed bilaterally with modifier 50?

Yes, CPT 23044 can be billed with modifier 50 when exploratory surgery is performed on both shoulders during the same operative session. Medicare typically reimburses bilateral procedures at 150% of the unilateral rate, which would be approximately $835.02 total. However, documentation must support medical necessity for exploring both shoulders simultaneously.

What is the global period for CPT 23044?

CPT 23044 has a 10-day global period. All routine postoperative care related to the exploratory surgery within these 10 days is included in the procedure payment. Evaluation and management services during the global period require modifier 24 if unrelated to the surgery, or modifier 58 if staging a related procedure.

How do I bill 23044 when exploration leads to definitive repair?

When exploration during 23044 leads to definitive repair during the same session, typically only the definitive repair code is billed. The exploratory component is considered inherent to the decision-making for the repair. Document the exploratory findings thoroughly, but expect 23044 to bundle. Only use modifier 59 if the exploration involved a truly distinct anatomic area separate from the repair site.