CPT 23333Surgery

Remove shoulder fb deep

CPT 23333 covers the surgical removal of a foreign object lodged deep within the shoulder tissues, requiring an incision and exploration beyond superficial layers. This typically involves objects embedded from trauma, penetrating injuries, or retained surgical materials.

Showing rates for

National Average

Base Medicare rate

$474.52

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

PE RVU (NF)

7.43

MP RVU

1.24

Total RVU

14.67

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

NCCI bundling edits

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Billing tips

Document depth and anatomical structures involved explicitly in operative report, clearly differentiating from superficial removal (10120-10121) which pays significantly less
Impact: Prevents downcoding to superficial foreign body removal codes that reimburse at $100-150, protecting approximately $324-374 per case
Verify and document foreign body location with pre-operative imaging (X-ray, CT, or ultrasound) and reference specific imaging findings in operative documentation
Impact: Reduces medical necessity denials by 60-75% and supports modifier 22 claims when location complexity justifies increased reimbursement
Bill only once per operative session even if multiple small fragments are removed from the same deep tissue plane; do not append modifier 51 or bill multiple units
Impact: Prevents audit flags and potential recoupment; multiple units typically denied with recovery of overpayment averaging $474.52 per duplicate claim
When performing concurrent procedures, review NCCI edits carefully; 23333 bundles with many shoulder arthroscopy codes and requires modifier 59 only with clear documentation of separate incisions/approaches
Impact: Appropriate modifier 59 use can recover $400-800 in otherwise bundled procedures; inappropriate use triggers audits with potential liability
Capture and document intraoperative fluoroscopy or imaging separately with 77002 when used for foreign body localization during the procedure
Impact: Additional $50-75 reimbursement when separately billable and properly documented with interpretation in operative note
For workers' compensation or liability cases, obtain pre-authorization before scheduling as these payers often require independent medical examination before approving foreign body removal

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Frequently asked questions

What is the difference between CPT 23333 and 10120 for foreign body removal?

CPT 23333 is for deep foreign body removal from shoulder structures requiring incision through muscle layers or joint capsule, while 10120 is for simple superficial removal from subcutaneous tissue. The key distinction is anatomical depth: 23333 involves dissection beyond subcutaneous fat into deep muscle, periarticular, or intra-articular spaces and reimburses at $474.52 versus approximately $100-150 for superficial codes.

How much does Medicare pay for CPT code 23333 in 2025?

Medicare pays $474.52 for CPT 23333 in 2025 based on the national average rate. Both facility and non-facility rates are identical at $474.52, with 14.67 total RVUs (6.0 work RVU, 7.43 PE RVU, 1.24 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 23333 be billed with shoulder arthroscopy codes?

CPT 23333 can be billed with shoulder arthroscopy codes only when the foreign body removal involves a separate incision and distinct anatomical approach outside the arthroscopic field. Modifier 59 is required, and documentation must clearly show the procedures were not integral components of a single surgical objective. Most payers bundle these services unless distinctly separate.

What modifiers are required when billing CPT 23333?

Laterality modifiers LT (left) or RT (right) are required for CPT 23333 by Medicare and most commercial payers. Additional modifiers may include 22 for increased complexity, 59 for distinct procedural service when billed with other shoulder procedures, 78 for related return to OR in postoperative period, or 52 for reduced/discontinued service.

Does CPT 23333 include removal of multiple foreign bodies?

Yes, CPT 23333 includes removal of multiple foreign bodies from the same deep tissue area during a single operative session. Do not bill multiple units or append modifier 51 when removing several fragments from the same anatomical region. If foreign bodies are in completely separate shoulder regions requiring distinct incisions, documentation must support separate procedures.

What documentation is needed to prevent denials for CPT 23333?

Essential documentation includes pre-operative imaging confirming foreign body location and depth, detailed operative note describing tissue planes dissected beyond subcutaneous layer, specific anatomical structures encountered (muscle, joint capsule), layered closure indicating deep involvement, and medical necessity justification such as pain, functional limitation, infection risk, or progressive migration. Lack of depth documentation commonly results in downcoding to superficial removal codes.

What is the global period for CPT 23333?

CPT 23333 has a 90-day global surgical period. All routine postoperative care within 90 days is included in the $474.52 reimbursement. Billing for related services during this period typically requires modifier 78 (related procedure in postop period) or 79 (unrelated procedure by same physician) with appropriate documentation to justify separate payment.