CPT 23071Surgery

Exc shoulder les sc 3 cm/>

CPT code 23071 is used when a surgeon removes a growth or abnormal tissue from the shoulder area that lies beneath the skin but above the muscle layer, measuring 3 centimeters or larger.

Showing rates for

National Average

Base Medicare rate

$416.62

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

5.91

PE RVU (NF)

5.6

MP RVU

1.37

Total RVU

12.88

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

NCCI bundling edits

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Billing tips

Measure and document lesion size in operative report in all three dimensions, explicitly stating the greatest dimension is 3cm or larger
Impact: Prevents downcoding to 23070 (lesions <3cm, pays $281.71) - a difference of $134.91 per procedure
Confirm lesion location is truly subcutaneous (between skin and muscle fascia) rather than subfascial, as depth determines code selection
Impact: Subfascial lesions require code 23075 or 23076 which have different reimbursement rates; incorrect depth coding is a top audit trigger
Include pathology report with claim submission when possible, especially for lesions near the 3cm threshold
Impact: Reduces medical record requests by 60-70% and accelerates payment; pathology specimen measurements support medical necessity
Do not separately bill intermediate or complex closure (12031-13160) as it is bundled into the excision code per NCCI edits
Impact: Prevents automatic denial and recoupment; wound closure is included in the $416.62 reimbursement
When performing multiple excisions, bill each lesion separately with modifier 59 if at distinct anatomic sites and document separate incisions
Impact: Allows payment for multiple lesions; without modifier 59, second excision may be denied as duplicate or bundled
Verify patient's surgical history for prior shoulder procedures as modifier 78 significantly reduces reimbursement during global period
Impact: Using modifier 78 when required prevents fraud allegations, but reduces payment to approximately $125-208 versus full $416.62

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 23071 in 2025?

The 2025 Medicare national average reimbursement for CPT 23071 is $416.62 for both facility and non-facility settings, based on 12.88 total RVUs and a conversion factor of 32.3465.

What is the difference between CPT code 23070 and 23071?

CPT 23070 is used for shoulder subcutaneous lesion excision less than 3cm in greatest dimension, while 23071 applies to lesions 3cm or greater. The size threshold of 3cm determines which code to use, with 23071 reimbursing approximately $135 more than 23070.

Can CPT 23071 be billed with an E/M code on the same day?

Yes, but only with modifier 25 appended to the E/M code if a separately identifiable evaluation and management service was performed beyond the decision for surgery. The E/M must be clearly documented as addressing issues distinct from the immediate preoperative assessment.

How should I measure the lesion to determine if it qualifies for 23071?

Measure the lesion in all three dimensions during the procedure and document the greatest dimension in the operative report. If the greatest dimension is 3.0cm or larger, use code 23071. Pathology specimen measurements can provide supporting documentation but clinical measurement during excision is the primary determinant.

What documentation is required to avoid denials for CPT 23071?

Required documentation includes explicit lesion size measurement of 3cm or greater, clear identification of subcutaneous depth, specific shoulder location with laterality, medical necessity justification, description of complete excision, and pathology submission. Inadequate size or depth documentation are the most common denial triggers.

Is wound closure separately billable with CPT code 23071?

No, wound closure is bundled into CPT 23071 and cannot be separately billed. This includes simple, intermediate, and complex closure codes (12001-13160). The $416.62 reimbursement includes all closure work, and attempting to bill closure separately will result in denial per NCCI edits.

What are the work RVUs for CPT code 23071?

CPT 23071 has 5.91 work RVUs, 5.6 practice expense RVUs (both facility and non-facility), and 1.37 malpractice RVUs, totaling 12.88 RVUs. These values are from the CMS 2025 Medicare Physician Fee Schedule released in December 2024.