CPT 23076Surgery

Exc shoulder tum deep < 5 cm

CPT 23076 covers the surgical removal of a deep tumor in the shoulder area that is smaller than 5 centimeters. This involves removing abnormal tissue growth located beneath the surface muscles of the shoulder.

Showing rates for

National Average

Base Medicare rate

$540.83

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

7.41

PE RVU (NF)

7.7

MP RVU

1.61

Total RVU

16.72

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

NCCI bundling edits

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Billing tips

Verify tumor size measurement in operative report matches <5cm threshold; tumors ≥5cm require 23077 instead
Impact: Incorrect code selection: 23077 reimburses at $675.31, creating $134.48 difference and audit risk
Document depth of dissection through fascia and muscle layers; superficial subcutaneous excisions require different codes (11400-11406 series)
Impact: Downcoding to subcutaneous excision reduces payment by $400-$450, representing 75% revenue loss
Always append RT or LT modifier for laterality; claims without laterality are auto-denied by Medicare and most commercial payers
Impact: Immediate denial requiring resubmission, delaying payment 30-60 days minimum
Submit pathology report with claim when possible, especially for malignancy; demonstrates medical necessity for deep excision approach
Impact: Reduces medical review requests by 60-70% and prevents unnecessary appeals
For tumors near 5cm, document exact measurements in 3 dimensions in operative note; use smallest dimension if border cases exist
Impact: Prevents auditor challenges and potential recoupment of overpayment difference
Check for separate reimbursement of complex wound closure; intermediate/complex repairs may be separately billable if closure exceeds typical effort
Impact: Additional $100-$300 potential revenue if 13100-13133 codes appropriately documented and billed with modifier 59

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23076 in 2025?

The 2025 Medicare national average reimbursement for CPT 23076 is $540.83 for both facility and non-facility settings. This rate is based on 16.72 total RVUs multiplied by the 2025 conversion factor of $32.3465.

What is the difference between CPT 23076 and 23077?

CPT 23076 is for deep shoulder tumor excision less than 5 cm, while 23077 is for tumors 5 cm or greater. The size threshold is critical: 23077 reimburses at $675.31, approximately $134.48 more than 23076. Documentation must clearly support the measured size to justify code selection.

How many RVUs is CPT code 23076 worth?

CPT 23076 has 16.72 total RVUs in 2025, comprising 7.41 work RVUs, 7.7 practice expense RVUs, and 1.61 malpractice RVUs. Both facility and non-facility PE RVUs are identical at 7.7 for this code.

Can CPT 23076 be billed bilaterally?

Yes, but bilateral shoulder deep tumor excisions during the same session are rare. Use modifier 50 for bilateral procedures or RT/LT modifiers for separate claims. Most payers reimburse bilateral procedures at 150% of the single procedure rate, though documentation must justify medical necessity for simultaneous bilateral excisions.

What modifiers are required for CPT 23076?

Laterality modifiers RT (right) or LT (left) are mandatory for CPT 23076. Other commonly applicable modifiers include 22 (increased procedural services), 59 (distinct procedural service), 78 (return to OR), and 79 (unrelated procedure during postop period). Missing laterality modifiers result in automatic claim denial.

Does CPT 23076 include wound closure?

Simple closure is included in CPT 23076 and cannot be separately billed. However, intermediate or complex closures requiring layered closure or extensive undermining may be separately reportable with appropriate closure codes (13100-13133) and modifier 59 if documentation supports work beyond typical closure for this procedure.

What documentation is needed to bill CPT 23076 without denial?

Required documentation includes tumor size measurements (all three dimensions with largest <5cm), depth documentation (subfascial/intramuscular), laterality, layer-by-layer dissection notes, margin assessment, pathology specimen submission, and preoperative imaging. Operative reports must clearly distinguish deep tumors from superficial subcutaneous lesions to prevent downcoding.