CPT 23400Surgery

Fixation of shoulder blade

CPT code 23400 covers surgical fixation of the shoulder blade (scapula), typically involving hardware placement to stabilize fractures or correct positioning. This is an open surgical procedure requiring internal fixation devices like plates, screws, or wires.

Showing rates for

National Average

Base Medicare rate

$959.72

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

13.87

PE RVU (NF)

12.98

MP RVU

2.82

Total RVU

29.67

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

NCCI bundling edits

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Billing tips

Always append laterality modifier (LT or RT) to prevent automatic denial; 23400 without laterality will reject at clearinghouse or payer level
Impact: Prevents 100% claim denial and resubmission delays of 30-45 days
Document hardware type, number, and placement locations in operative note; specify plate size, number of screws, and anatomic landmarks for fixation sites
Impact: Reduces audit risk and supports use of modifier 22 when applicable, potentially increasing reimbursement by $200-300
Bill facility and non-facility rates correctly based on place of service; 23400 has identical facility and non-facility rates at $959.72, but this is unusual and should be verified on claim
Impact: Ensures proper reimbursement of $959.72 regardless of setting
When performed with clavicle or other shoulder girdle fracture fixation, sequence codes by RVU value with highest first to maximize reimbursement under multiple procedure rules
Impact: At 29.67 RVUs, 23400 should typically be primary code; proper sequencing prevents unnecessary reimbursement reduction of $480+ on primary procedure
For comminuted or complex scapular fractures requiring extensive reconstruction, prepare modifier 22 documentation before claim submission including comparison of typical vs actual operative time and complexity
Impact: Increases approval rate for additional payment of 20-30% ($192-288) when complexity justifies increased work
Verify diagnosis code supports medical necessity; use specific scapular fracture codes (S42.1xx series) with appropriate encounter type and avoid unspecified fracture codes

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23400 in 2025?

The 2025 Medicare national average reimbursement for CPT 23400 is $959.72 for both facility and non-facility settings. This rate is based on 29.67 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement may vary by geographic locality adjustment.

How many RVUs is CPT code 23400 worth?

CPT 23400 has 29.67 total RVUs, consisting of 13.87 work RVUs, 12.98 practice expense RVUs (both facility and non-facility), and 2.82 malpractice RVUs based on the 2025 Medicare Physician Fee Schedule.

What modifiers are required when billing CPT 23400?

Laterality modifiers LT (left) or RT (right) are mandatory for CPT 23400. Additional modifiers like 22 (increased procedural services), 51 (multiple procedures), or 59 (distinct procedural service) may be appropriate depending on case complexity and other procedures performed during the same session.

Can CPT 23400 be billed bilaterally?

While technically possible to bill 23400 bilaterally using modifier 50, bilateral scapular fractures requiring simultaneous fixation are extremely rare. If performed, comprehensive documentation of medical necessity for bilateral surgery during a single session is essential for reimbursement approval.

What diagnosis codes support medical necessity for CPT 23400?

CPT 23400 is typically supported by ICD-10 codes in the S42.1xx series for scapular fractures, including fractures of the scapular body (S42.11x), acromion process (S42.12x), coracoid process (S42.13x), glenoid (S42.14x), and scapular neck (S42.15x). Seventh character indicates encounter type (A for initial, D for subsequent, etc.).

Is CPT 23400 bundled with shoulder arthroplasty or rotator cuff repair?

CPT 23400 may be subject to bundling edits with certain shoulder procedures. Check the National Correct Coding Initiative (NCCI) edits before billing together. If procedures are distinct and separately documented (different fracture site, different session, or unrelated pathology), modifier 59 may be appropriate to override bundling.

What documentation is needed to support modifier 22 with CPT 23400?

To support modifier 22 for increased complexity with 23400, document significantly increased operative time compared to typical cases, extensive comminution requiring multiple fixation points, revision of previous failed fixation, severe soft tissue injury complicating approach, or anatomic variations requiring unusual technique. Include comparative statement of typical versus actual work and request 20-30% additional payment.