CPT 23334Surgery

Shoulder prosthesis removal

CPT code 23334 covers the surgical removal of a shoulder replacement (prosthesis) that was previously implanted. This is distinct from the initial shoulder replacement surgery and involves taking out the artificial joint components.

Showing rates for

National Average

Base Medicare rate

$1,046.73

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

15.5

PE RVU (NF)

13.83

MP RVU

3.03

Total RVU

32.36

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

NCCI bundling edits

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Billing tips

Always append laterality modifiers (LT/RT) as they are mandatory for shoulder procedures; failure to include will result in automatic denial
Impact: Prevents 100% claim denial and delays in payment by 30-60 days
Consider modifier 22 for increased procedural services when dealing with infected prostheses, severe bone loss, or cemented components requiring extended operative time; submit operative report with claim showing time-in/time-out and complexity narrative
Impact: Can increase reimbursement by $200-500 (20-50% above base $1046.73) when properly documented
For two-stage revision protocols, use modifier 58 on the removal procedure to indicate this is a planned staged approach, and ensure documentation clearly states intent for future reimplantation
Impact: Protects full $1046.73 payment and prevents bundling denials on subsequent reimplantation procedure
Verify facility vs non-facility status before billing; 23334 has identical rates ($1046.73) for both settings, but setting affects allowed ancillary charges and patient responsibility
Impact: Ensures accurate patient cost-sharing calculations and prevents facility fee disputes
Do not bill 23334 with same-day shoulder arthroplasty codes (23470, 23472, 23473, 23474) unless using modifier 59 with clear documentation of distinct surgical sessions or bilateral procedures
Impact: Prevents NCCI edits that would bundle and deny the removal component, resulting in loss of $1046.73
Document all removed components separately (humeral stem, glenoid component, etc.) and specify indication for removal (infection, loosening, wear) as this supports medical necessity and appeals

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23334 in 2025?

The 2025 Medicare national average payment for CPT 23334 is $1046.73 for both facility and non-facility settings. This is based on 32.36 total RVUs (15.5 work RVU, 13.83 PE RVU, 3.03 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 23334 be billed with a shoulder replacement code on the same day?

Generally no, unless using appropriate modifiers. If removal and reimplantation occur during the same operative session, NCCI edits may bundle 23334 into the reimplantation code. Use modifier 59 or staged procedure modifiers (58) only when procedures are truly distinct or planned as separate stages. Two-stage revisions performed on different dates can be billed separately without modifiers.

What modifiers are most commonly used with CPT code 23334?

The most common modifiers for 23334 are LT/RT (laterality, mandatory), modifier 22 (increased procedural services for complex removals), modifier 58 (staged procedure for planned two-stage revisions), and modifier 78 (return to OR for complication during global period). Laterality modifiers are required on every claim.

How many RVUs is CPT 23334 worth in 2025?

CPT 23334 has 32.36 total RVUs in 2025, consisting of 15.5 work RVUs, 13.83 practice expense RVUs (both facility and non-facility), and 3.03 malpractice RVUs. This makes it a high-value procedure code reflecting the complexity of prosthesis removal surgery.

What documentation is required to bill CPT 23334?

Documentation must include the medical indication for removal (infection, loosening, failure), laterality, surgical approach, specific components removed, bone quality, presence of cement and removal technique, any specimens sent for analysis, operative time, and future treatment plan. For modifier 22, additional documentation showing increased complexity and extended time is required.

Is CPT 23334 performed as inpatient or outpatient?

CPT 23334 can be performed in either inpatient or outpatient settings depending on patient factors and whether reimplantation is planned. The Medicare payment is the same ($1046.73) for both facility types. Infected prosthesis removals and two-stage revisions are more commonly inpatient, while isolated removals for loosening may be outpatient.

What are common reasons for denial of CPT 23334 claims?

Common denials include missing laterality modifiers, inappropriate bundling with other shoulder procedures without proper modifiers, lack of medical necessity documentation, and incorrect use during global periods. Appeals should include operative reports, imaging studies, lab results supporting the indication, and proper modifier justification.