CPT 23130Surgery

Acromp/acromionectomy prtl

CPT code 23130 is used when a surgeon removes part of the acromion (the bony projection on the shoulder blade) to relieve shoulder pain and impingement. This procedure creates more space for the rotator cuff tendons to move freely.

Showing rates for

National Average

Base Medicare rate

$616.52

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

7.77

PE RVU (NF)

9.72

MP RVU

1.57

Total RVU

19.06

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

NCCI bundling edits

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Billing tips

Verify whether procedure was performed via open or arthroscopic approach before coding; arthroscopic acromioplasty uses 29826, not 23130
Impact: Code misassignment can result in $200-400 payment variance and 100% denial risk if payer identifies approach mismatch
When billing 23130 with rotator cuff repair codes (23410-23420), append modifier 59 to 23130 only if acromioplasty is performed at separate site or is clearly distinct from cuff repair
Impact: Improper modifier use results in bundling denials worth $616.52; many payers consider acromioplasty integral to rotator cuff repair
Document specific measurements of acromial resection and bone removed (in millimeters) to support partial versus complete acromionectomy distinction
Impact: Prevents downcoding to unlisted procedure code or denials; auditors look for quantifiable documentation to justify 7.77 work RVUs
Always append laterality modifier (LT/RT); this is mandatory for all bilateral anatomic structures per NCCI edits
Impact: Missing laterality causes automatic claim rejection or denial worth full payment of $616.52 until corrected
Check for pre-authorization requirements; most commercial payers require prior authorization for all shoulder surgeries including 23130
Impact: Missing authorization can result in 100% denial ($616.52) even with perfect coding and documentation
When performed bilaterally (modifier 50), submit single line item rather than two separate lines unless payer-specific guidelines require otherwise
Impact: Incorrect claim format causes processing delays and potential underpayment of approximately $308.26

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23130 in 2025?

The 2025 Medicare national average reimbursement for CPT 23130 is $616.52 for both facility and non-facility settings, based on 19.06 total RVUs and the 2025 conversion factor of 32.3465.

Can CPT 23130 be billed with rotator cuff repair codes?

CPT 23130 may be billed with rotator cuff repair codes (23410-23420) only when the acromioplasty is a distinct procedural service performed at a separate anatomic site or clearly documented as separate from the cuff repair. Modifier 59 must be appended to 23130, and many payers bundle these services as the acromioplasty is often considered integral to rotator cuff repair.

What is the difference between CPT 23130 and 29826?

CPT 23130 describes an open partial acromionectomy performed through a direct surgical incision, while CPT 29826 describes an arthroscopic acromioplasty performed using a scope and small portals. The surgical approach determines which code to use; using the wrong code based on approach will result in denials.

How many RVUs is CPT code 23130 worth?

CPT 23130 has a total RVU value of 19.06 for 2025, consisting of 7.77 work RVUs, 9.72 practice expense RVUs (both facility and non-facility), and 1.57 malpractice RVUs.

Is prior authorization required for CPT 23130?

Most commercial insurance payers require prior authorization for CPT 23130 as it is a surgical shoulder procedure. Medicare typically does not require prior authorization, but Medicare Advantage plans often do. Always verify authorization requirements with the specific payer before scheduling surgery to avoid denials.

What documentation is needed to bill CPT 23130?

Required documentation includes operative report clearly stating open approach, specific portion of acromion removed with measurements, laterality, failed conservative treatment timeline, pre- and post-operative diagnoses, and clear differentiation from complete acromionectomy. Medical necessity must be supported by imaging and clinical findings of impingement syndrome.

What modifiers are required when billing CPT 23130?

Laterality modifiers RT (right) or LT (left) are mandatory for CPT 23130. Additional modifiers may include 50 for bilateral procedures, 51 for multiple procedures, 59 for distinct procedural service when billed with potentially bundled codes, 22 for increased complexity, or 78 for related procedures during postoperative period.