CPT 23405Surgery

Incision of tendon & muscle

CPT code 23405 describes a surgical procedure where the surgeon makes an incision into tendons and muscles of the shoulder area to release tension, remove scar tissue, or address contractures. This is an open surgical technique requiring direct visualization and manipulation of soft tissue structures.

Showing rates for

National Average

Base Medicare rate

$608.44

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

8.54

PE RVU (NF)

8.74

MP RVU

1.53

Total RVU

18.81

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

NCCI bundling edits

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Billing tips

Document specific tendon and muscle structures incised with anatomical detail (e.g., subscapularis, pectoralis major, biceps tendon) to support medical necessity and differentiate from other shoulder procedures
Impact: Prevents denials for insufficient documentation and supports use of modifier 22 when applicable, potentially increasing reimbursement by $121-$304
Verify that the procedure is truly an open incision technique and not an arthroscopic release, which would require different CPT codes (29820-29825 range)
Impact: Prevents upcoding allegations and automatic denials; arthroscopic codes have different RVU values and reimbursement structures
When billing with modifier 50 for bilateral procedures, confirm payer-specific policies as some require modifier 50 while others require two line items with RT/LT modifiers
Impact: Ensures proper payment of $912.66 for bilateral procedures instead of denial or underpayment at single procedure rate of $608.44
Capture operative time, complexity factors, and complications requiring additional work to justify modifier 22 when procedure exceeds typical difficulty
Impact: With proper documentation, modifier 22 can increase reimbursement by 20-50% ($121.69-$304.22 additional payment)
Review the operative note for any concurrent debridement, repair, or reconstruction procedures that may be separately billable and not bundled with 23405
Impact: Identifies additional revenue opportunities; proper sequencing with modifier 51 can capture 50% of secondary procedure value
Ensure laterality modifiers (RT/LT) are appended for all claims as most payers now require this information even for unilateral procedures

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23405 in 2025?

The 2025 Medicare national average reimbursement for CPT 23405 is $608.44 for both facility and non-facility settings. This rate is based on 18.81 total RVUs (8.54 work RVU, 8.74 practice expense RVU, and 1.53 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

What does CPT code 23405 cover?

CPT 23405 covers the surgical incision of tendon and muscle tissue in the shoulder region. This is an open procedure performed to release contractures, lyse adhesions, or decompress compartments affecting shoulder mobility. The procedure involves direct surgical access with visualization and manipulation of tendon-muscle units.

Can CPT 23405 be billed bilaterally?

Yes, CPT 23405 can be billed bilaterally when the procedure is performed on both shoulders during the same operative session. Use modifier 50 or separate line items with RT/LT modifiers depending on payer policy. Bilateral procedures typically reimburse at 150% of the single procedure rate ($912.66 total).

What modifiers are commonly used with CPT 23405?

Common modifiers for CPT 23405 include 50 (bilateral procedure), 51 (multiple procedures), RT/LT (laterality), 22 (increased procedural services for unusual complexity), 78 (return to OR for complication), and 79 (unrelated procedure during postoperative period). Proper modifier use is essential for accurate reimbursement.

How does CPT 23405 differ from arthroscopic shoulder procedures?

CPT 23405 is an open surgical procedure requiring a skin incision and direct visualization of tendons and muscles. Arthroscopic procedures (codes 29820-29825) use small portals and camera visualization. Billing 23405 for an arthroscopic procedure constitutes incorrect coding and will result in claim denial or audit risk.

What documentation is required to bill CPT 23405?

Documentation must include pre-operative diagnosis, evidence of failed conservative treatment, detailed operative note specifying tendons and muscles incised, anatomical approach, technique used, laterality, and post-operative status. The operative note should clearly demonstrate this was an open procedure with direct surgical access, not arthroscopic visualization.

What are the most common denial reasons for CPT 23405?

Common denials include lack of medical necessity documentation, incorrect coding when procedure was performed arthroscopically, bundling with other shoulder procedures, and missing laterality modifiers. Appeals require submission of conservative treatment records, detailed operative notes, and appropriate modifier justification.