CPT 23335Surgery

Shoulder prosthesis removal

CPT code 23335 covers the surgical removal of a shoulder prosthesis (artificial shoulder joint), typically performed when the implant has failed, become infected, or causes chronic pain.

Showing rates for

National Average

Base Medicare rate

$1,242.75

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)

15.7

MP RVU

3.72

Total RVU

38.42

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

NCCI bundling edits

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Billing tips

Document whether removal is single-stage explantation or first stage of two-stage revision, as this affects subsequent billing and global period considerations
Impact: Proper staging documentation enables billing for second-stage reimplantation (23472) with modifier 58, preserving $2000+ in additional reimbursement
Ensure operative report specifies all components removed (humeral stem, glenoid component, cement) and preservation or sacrifice of rotator cuff attachments
Impact: Detailed component documentation prevents downcoding to 23330 (partial removal) which pays approximately $300 less
For infected cases, separately bill for cultures, tissue biopsy (20225), and pathology interpretation to capture full service value
Impact: Additional $150-300 in reimbursement for properly documented ancillary services
Apply modifier 22 when bone loss exceeds 30% of glenoid or significant humeral bone grafting is required, with operative time documentation showing 50%+ increase
Impact: Successful modifier 22 claims can increase reimbursement by $250-600 depending on payer and documentation quality
Verify that pre-authorization includes CPT 23335 specifically, not just 'shoulder revision,' as some payers pre-authorize reimplantation (23472) but not explantation alone
Impact: Prevents denials requiring time-consuming appeals; authorization errors cost average 45 days in payment delay
Bill hospital facility codes separately including implant removal tray, antibiotic cement if used for spacer, and any bone void fillers with appropriate HCPCS codes
Hospital can capture additional $500-2000 in device and supply costs often overlooked in explantation procedures

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 23335 in 2025?

The 2025 Medicare national average reimbursement for CPT 23335 is $1242.75 for both facility and non-facility settings, based on 38.42 total RVUs and the conversion factor of 32.3465.

What is the difference between CPT 23335 and 23472?

CPT 23335 covers removal of a shoulder prosthesis without replacement (explantation only), while CPT 23472 describes revision shoulder arthroplasty where the prosthesis is removed and a new implant is inserted during the same operative session. Code 23335 is typically used in two-stage revisions or permanent explantation scenarios.

Can CPT 23335 be billed with irrigation and debridement codes?

Debridement inherent to the prosthesis removal is included in 23335 and cannot be separately billed. However, extensive debridement beyond the scope of typical removal (affecting separate tissue planes or requiring significant additional time) may be separately billable with modifier 59 and thorough documentation supporting the distinct nature of the service.

How many RVUs is CPT code 23335 worth?

CPT 23335 has 38.42 total RVUs in 2025, consisting of 19.00 work RVUs, 15.70 practice expense RVUs, and 3.72 malpractice RVUs, reflecting the complexity and risk of shoulder prosthesis removal surgery.

Does CPT 23335 require prior authorization from Medicare?

While traditional Medicare does not routinely require prior authorization for 23335, Medicare Advantage plans frequently do require pre-authorization for this procedure. Additionally, commercial payers almost universally require prior authorization due to the high cost and need to verify medical necessity for prosthesis removal.

What diagnosis codes support medical necessity for CPT 23335?

Common supporting ICD-10 codes include T84.53XA (infection of shoulder joint prosthesis), T84.031A (mechanical loosening), M25.512 (pain in left shoulder) with history of arthroplasty, M96.661 (fracture following insertion of orthopedic implant), and Z96.611 (presence of artificial shoulder joint) combined with complication codes.

Can you bill for antibiotic spacer placement with CPT 23335?

CPT 23335 includes placement of an antibiotic cement spacer as part of the explantation procedure. The spacer is not considered a prosthetic implant but rather a temporary device to maintain soft tissue tension and deliver local antibiotics. Separately billing for spacer insertion would be considered unbundling and is not appropriate.