CPT 23075Surgery

Exc shoulder les sc < 3 cm

CPT code 23075 covers the surgical removal of a small growth or abnormal tissue (lesion) from the shoulder area that sits just under the skin (subcutaneous), measuring less than 3 centimeters in diameter. This is a minor surgical procedure typically performed to remove lipomas, cysts, or other benign masses from the shoulder region.

Showing rates for

National Average

Base Medicare rate

$499.75

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

4.21

PE RVU (NF)

10.35

MP RVU

0.89

Total RVU

15.45

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

NCCI bundling edits

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Billing tips

Verify and document lesion size measurement in operative report with both pre-operative imaging (ultrasound/MRI) and intraoperative measurement
Impact: Prevents automatic downcoding; lesions measuring 3cm or larger must be coded to higher-paying codes (23071-23073), while incorrect upcoding can trigger $172-500+ recoupments per claim
Bill in non-facility setting when possible (office-based procedure room or ASC owned by practice)
Impact: Increases reimbursement by $172.73 per procedure ($499.75 vs $327.02), representing a 52.8% payment increase
Always append laterality modifier (LT or RT) on initial claim submission
Impact: Prevents automatic denial and 15-30 day payment delay; resubmissions may face additional scrutiny and potential medical record requests
Document the depth and layer of excision explicitly; ensure operative note states 'subcutaneous' or 'superficial to the fascia'
Impact: Prevents confusion with deeper excisions (23075 vs 23077) which have different reimbursement; unclear documentation causes denials averaging 30-45 days to resolve
When multiple lesions are excised, bill each separately with modifier 59 only if in different anatomic locations or clearly distinct
Impact: Appropriate use can increase revenue by full value of additional procedures; inappropriate use triggers NCCI edits and potential fraud investigation
Obtain pathology report confirming excision and include diagnosis code that matches pathology findings on any corrected claims
Impact: Supports medical necessity on appeal; malignant findings may justify additional reimbursement considerations and reduces denial rate by approximately 40%

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 23075 in 2025?

For 2025, Medicare pays $499.75 for CPT 23075 in non-facility settings and $327.02 in facility settings (hospital or ASC). The rate is based on 15.45 total RVUs multiplied by the 2025 conversion factor of 32.3465. Non-facility rates are higher because the practice assumes overhead costs for supplies, equipment, and space.

What size lesion is covered by CPT code 23075?

CPT 23075 covers excision of shoulder lesions measuring less than 3 centimeters in greatest diameter. The size must be documented in the operative report based on measurement of the actual lesion, not the incision length. Lesions measuring 3 cm or larger require different CPT codes (23071-23073) based on specific size thresholds.

Can CPT 23075 be billed with an office visit on the same day?

Yes, but only if the office visit represents a significant, separately identifiable evaluation and management service beyond the decision for surgery. You must append modifier 25 to the E/M code (99212-99215) and document a distinct evaluation addressing other conditions or comprehensive assessment beyond the lesion excision itself. Without modifier 25, the E/M will bundle into the surgical code.

What is the difference between CPT 23075 and 23077?

CPT 23075 is for excision of subcutaneous lesions (superficial to the fascia layer) while 23077 is for deeper excisions involving subfascial or intramuscular lesions, both under 3 cm. The key distinction is anatomic depth, not size. Documentation must explicitly state whether the lesion was superficial or deep to the fascia, as 23077 commands higher reimbursement due to increased surgical complexity.

How many RVUs is CPT code 23075 worth?

CPT 23075 has 15.45 total RVUs for 2025, consisting of 4.21 work RVUs, 10.35 non-facility practice expense RVUs (5.01 for facility), and 0.89 malpractice RVUs. The work RVU represents physician effort and skill, while practice expense varies significantly based on whether the procedure is performed in a facility versus office setting.

Does CPT 23075 require a pathology report?

While not explicitly required by CPT guidelines, best practice and most payer policies expect specimens excised under 23075 to be sent for pathological examination. The pathology report supports medical necessity, confirms complete excision, and provides definitive diagnosis. Many payers will deny claims for lack of medical necessity if no pathology was performed, especially on appeal review.

Can you bill CPT 23075 for multiple lesions on the same shoulder?

Yes, you can bill 23075 multiple times for separate lesions in the same shoulder region, but each must be clearly documented as a distinct lesion with separate excisions. Append modifier 59 to subsequent procedures and document size, exact location, and pathology for each lesion separately. Expect higher scrutiny and potential bundling edits; some payers may require modifier 76 or detailed operative notes showing distinct surgical sites.