CPT 23073Surgery

Exc shoulder tum deep 5 cm/>

CPT code 23073 is used when a surgeon removes a deep tumor or abnormal growth from the shoulder area that is 5 centimeters or larger. This is a complex surgical procedure that involves cutting through multiple tissue layers to access and remove the mass.

Showing rates for

National Average

Base Medicare rate

$688.01

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

10.13

PE RVU (NF)

8.9

MP RVU

2.24

Total RVU

21.27

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

NCCI bundling edits

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Billing tips

Verify tumor size measurement of ≥5cm is documented in both preoperative imaging report and operative note, using actual measured dimensions rather than estimates
Impact: Prevents downcoding to 23071 (tumor <3cm, $395.89) or 23072 (3-5cm, $540.37), protecting $147.64-292.12 in reimbursement
Document depth of tumor as subfascial or intramuscular with specific anatomic layers dissected through (deltoid, rotator cuff muscles, or deeper structures)
Impact: Differentiates from subcutaneous excision codes 23075-23076 which reimburse $130-250 less; prevents denial requiring depth confirmation
Bill pathology separately with appropriate CPT code 88305 for surgical pathology examination of soft tissue tumor; never bundle with surgical code
Impact: Captures additional $80-120 in professional component revenue that is separately billable and commonly overlooked
For tumors requiring frozen section analysis, bill 88331 separately and document medical necessity for intraoperative pathologic consultation
Impact: Additional $45-65 reimbursement for frozen section when appropriately documented as necessary for surgical decision-making
When complex wound closure or reconstruction required after tumor excision, consider separate billing for intermediate/complex repair (12031-13160) or flap procedures if criteria met
Impact: Potential additional $150-800 depending on wound size and closure complexity; requires modifier 59 and clear documentation that closure exceeded usual technique
Submit operative report with claim submission for procedures over 10 RVUs to prevent automatic review delays and expedite payment

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 23073 in 2025?

The 2025 Medicare national average reimbursement rate for CPT code 23073 is $688.01 for both facility and non-facility settings. This is based on 21.27 total RVUs (10.13 work RVU, 8.9 PE RVU, 2.24 MP RVU) multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on GPCI adjustments.

What is the difference between CPT codes 23071, 23072, and 23073?

These codes differ by tumor size: 23071 is for tumors less than 3cm ($395.89), 23072 is for tumors 3-5cm ($540.37), and 23073 is for tumors 5cm or greater ($688.01). All three describe deep (subfascial or intramuscular) shoulder tumor excisions. Accurate measurement documentation is critical as the size threshold directly determines the appropriate code and reimbursement level.

Can CPT 23073 be billed with modifier 22 for unusual complexity?

Yes, modifier 22 is appropriate when the shoulder tumor excision requires significantly greater work than typical due to factors like extensive scarring, proximity to brachial plexus or major vessels, unusual tumor vascularity, or patient anatomy complications. Documentation must clearly describe the additional complexity and increased operative time (typically 25-50% longer than usual). Additional payment of 20-30% is possible but requires compelling narrative justification.

Is CPT 23073 a facility-only code or can it be performed in office settings?

CPT 23073 is typically performed in hospital outpatient departments or ambulatory surgery centers due to the complexity and depth of the procedure requiring anesthesia. While both facility and non-facility rates are $688.01, the PE RVUs reflect that this procedure requires surgical facility resources. Office-based surgery is uncommon for deep tumors ≥5cm due to anesthesia requirements and potential complications.

What diagnosis codes are typically used with CPT 23073?

Common ICD-10 codes include D21.11 (benign neoplasm of connective tissue of right shoulder), D21.12 (left shoulder), C49.11/C49.12 (malignant neoplasm of connective tissue of shoulder), D48.1 (neoplasm of uncertain behavior of connective tissue), and M79.89 (other specified soft tissue disorders). The specific diagnosis should match pathology findings and preoperative imaging interpretation.

How do you document the 5cm size requirement for CPT 23073?

Size must be documented in at least two places: preoperative imaging report (MRI or CT with radiologist measurements) and operative note (surgeon's measured dimensions of tumor in situ or after excision). Documentation should state the largest dimension is ≥5cm. If there is discrepancy between imaging and operative measurements, the larger measurement supports code selection. Pathology specimen size provides corroborating evidence.

What is the global period for CPT code 23073?

CPT 23073 has a 90-day global surgical period. This means the Medicare payment of $688.01 includes all related preoperative evaluation (day before through day of surgery), the procedure itself, and all routine postoperative care for 90 days following surgery. Complications requiring return to OR use modifier 78; unrelated E/M services during global period require modifier 24.