CPT 23350Surgery

Injection for shoulder x-ray

CPT 23350 covers the injection of contrast dye into the shoulder joint to make structures visible on X-rays or other imaging studies. This procedure, called shoulder arthrography, helps doctors diagnose tears, inflammation, and other joint problems that don't show up well on regular X-rays.

Showing rates for

National Average

Base Medicare rate

$152.68

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)

3.62

MP RVU

0.1

Total RVU

4.72

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

NCCI bundling edits

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Billing tips

Always verify site of service designation before billing—non-facility setting pays $152.68 vs facility $47.87, a difference of $104.81 per procedure
Impact: Incorrect POS code results in automatic recoupment of $104.81 overpayment plus potential fraud investigation
Bill the injection procedure (23350) separately from the imaging supervision and interpretation codes (73040 for shoulder arthrography or 73222 for MRI arthrography)
Impact: Coordinating with radiology department prevents unbundling denials; combined billing can yield $300-500 total reimbursement
Document medical necessity showing why non-contrast imaging was inadequate; include prior imaging reports and failed conservative treatment
Impact: Prevents LCD/NCD denials; approximately 18% of arthrography claims denied for lack of medical necessity documentation
Use RT or LT modifier on every claim without exception; bilateral procedures (50 modifier) are extremely rare and require exceptional documentation
Impact: Missing laterality modifier causes 100% claim rejection or delay; bilateral claims face 85% denial rate without supporting documentation
Do not bill 23350 with therapeutic joint injection codes (20610) on same shoulder same date; these are considered mutually exclusive
Impact: Prevents NCCI edit denials; attempting to bill both results in automatic denial of lower-paying code and potential prepayment review
Time the procedure with imaging appointment to avoid 'injection without imaging' denials; document imaging performed same date in procedure note
Many payers deny 23350 if no corresponding imaging CPT billed within same date of service; can result in 100% payment denial

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23350 in 2025?

Medicare pays $152.68 for CPT 23350 in non-facility settings and $47.87 in facility settings under the 2025 Physician Fee Schedule. The rate difference reflects practice expense costs for equipment and staff in office-based settings versus hospital outpatient departments.

Can CPT 23350 be billed with an E/M code on the same day?

Yes, but only with modifier 25 appended to the E/M code and documentation showing a separately identifiable evaluation beyond the decision to perform the injection. The E/M must address a distinct problem or represent a significant, separately identifiable service. Most payers will deny the E/M without clear documentation of separate medical necessity.

What imaging codes are typically billed with CPT 23350?

CPT 23350 is commonly billed with 73040 (shoulder arthrography radiologic supervision and interpretation), 73222 (MRI shoulder with contrast), or 73202 (CT shoulder with contrast). The injection code 23350 represents only the needle placement and contrast injection, while imaging codes cover the actual diagnostic imaging and interpretation performed afterward.

Do I need a modifier RT or LT when billing CPT 23350?

Yes, laterality modifiers RT (right) or LT (left) are required by Medicare and most commercial payers when billing CPT 23350. Failure to include the appropriate laterality modifier will result in claim rejection or denial. Never use bilateral modifier 50 unless truly performing injections in both shoulders, which is clinically rare.

What RVUs are assigned to CPT 23350 for 2025?

CPT 23350 has a total RVU of 4.72 for 2025, consisting of 1.0 work RVU, 3.62 non-facility practice expense RVU (0.38 facility PE RVU), and 0.1 malpractice RVU. Using the 2025 conversion factor of 32.3465, this yields the national average payment rates of $152.68 non-facility and $47.87 facility.

Can CPT 23350 be billed with therapeutic shoulder injection code 20610?

No, CPT 23350 (diagnostic arthrography injection) and 20610 (therapeutic major joint injection) should not be billed together for the same shoulder on the same date. These codes are considered mutually exclusive by NCCI edits. Code 23350 is specifically for contrast injection for imaging purposes, while 20610 is for therapeutic medication injection.

What documentation is needed to support medical necessity for CPT 23350?

Documentation must include the clinical indication for arthrography, prior imaging reports showing inconclusive findings on non-contrast studies, physical examination findings, failed conservative treatment when applicable, and the specific diagnostic question being addressed. Many payers require proof that standard MRI or X-ray was inadequate before approving payment for contrast-enhanced arthrography.