CPT 23107Surgery

Explore treat shoulder joint

CPT code 23107 covers surgical exploration and treatment of the shoulder joint, typically performed to diagnose and address internal shoulder problems that cannot be identified through imaging alone. This involves opening the shoulder joint to directly visualize structures and perform necessary treatment during the same operative session.

Showing rates for

National Average

Base Medicare rate

$660.84

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

8.87

PE RVU (NF)

9.77

MP RVU

1.79

Total RVU

20.43

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

NCCI bundling edits

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Billing tips

Always document whether the exploration was planned or resulted from conversion from arthroscopy, as this affects code selection and medical necessity
Impact: Prevents downcoding to arthroscopy codes (29805-29828) which reimburse $400-900 less than open exploration
Verify facility vs non-facility setting matches claim submission, though both reimburse identically at $660.84 for this code
Impact: While payment is same for 23107, incorrect place of service codes trigger audits and can affect other bundled services
Document all treatment performed during exploration separately; removal of loose bodies or debridement may justify additional codes if substantial
Impact: Appropriate use of codes 23101 (loose body removal) or 23020 (capsular release) with modifier 59 can add $300-500 when medically necessary
Include pre-operative diagnostic imaging reports and their limitations in supporting documentation to establish medical necessity for open approach
Impact: Reduces denial rate by 40-60% for procedures that might appear to duplicate diagnostic arthroscopy
For conversion from arthroscopy to open, ensure operative note clearly documents why arthroscopic completion was not possible
Impact: Allows billing both arthroscopy and open exploration with appropriate modifiers, potentially increasing total reimbursement by $400-600
Submit claims within 30 days of service and verify correct ICD-10 codes showing progressive symptoms or failed prior treatment
Impact: Timely filing with proper diagnosis coding reduces denial rate by approximately 25% and accelerates payment by 2-3 weeks

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23107 in 2025?

The 2025 Medicare national average reimbursement for CPT 23107 is $660.84 for both facility and non-facility settings, based on 20.43 total RVUs and a conversion factor of 32.3465.

Can CPT 23107 be billed with shoulder arthroscopy codes?

Yes, but only when converting from arthroscopy to open exploration during the same session due to inadequate visualization or unexpected findings. Use modifier 59 on the secondary procedure and document clearly why both approaches were medically necessary.

What is the difference between CPT 23107 and shoulder arthroscopy codes?

CPT 23107 is an open surgical procedure requiring an incision through the joint capsule for direct visualization, while arthroscopy codes (29805-29828) involve minimally invasive camera-assisted techniques. The open approach allows more extensive exploration and direct palpation but has higher reimbursement and different documentation requirements.

What modifiers are required when billing CPT 23107?

Laterality modifiers LT or RT are mandatory for CPT 23107. Additional modifiers may include 50 (bilateral), 51 (multiple procedures), 22 (increased complexity), 59 (distinct procedure), or 78 (return to OR during global period) depending on the specific clinical circumstances.

How many RVUs is CPT 23107 worth in 2025?

CPT 23107 has 20.43 total RVUs in 2025, consisting of 8.87 work RVUs, 9.77 practice expense RVUs (both facility and non-facility), and 1.79 malpractice RVUs.

What documentation is needed to avoid denials for CPT 23107?

Essential documentation includes clear medical necessity for open approach over arthroscopy, detailed description of all structures examined, specific pathology identified and treated, laterality, and justification for any conversion from arthroscopic approach. Pre-operative imaging showing limitations and comprehensive operative notes significantly reduce denial risk.

What are common reasons for CPT 23107 claim denials?

The most common denials include insufficient medical necessity documentation, missing laterality modifiers, inappropriate bundling with arthroscopy codes, and lack of clear justification for open versus arthroscopic approach. Appeals should include detailed operative notes, imaging reports, and clinical rationale for the chosen surgical approach.