CPT 23406Surgery

Incise tendon(s) & muscle(s)

CPT code 23406 covers a surgical procedure where a surgeon cuts through tendons and muscles in the shoulder area to release tightness or contracture. This is typically done to restore motion and function when soft tissues have become shortened or scarred.

Showing rates for

National Average

Base Medicare rate

$728.12

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

11.01

PE RVU (NF)

9.94

MP RVU

1.56

Total RVU

22.51

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

NCCI bundling edits

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Billing tips

Ensure operative report clearly documents the number and specific identification of tendons and muscles released, as vague documentation may result in downcoding to a lesser procedure
Impact: Prevents downcoding that could reduce reimbursement by $200-400 or trigger complete denial
Verify that the procedure is not bundled with rotator cuff repair codes (29827, 23410-23420) when performed together; proper sequencing and modifier 59 application is critical
Impact: Correct unbundling can preserve the full $728.12 payment versus complete denial or 50% reduction
When billing with modifier 22, include a cover letter with the claim detailing percentage of additional time/work and specific complexity factors such as extensive scar tissue or revision surgery
Impact: Properly documented modifier 22 claims can increase payment by $145-364 (20-50% uplift)
Confirm that the diagnosis code supports medical necessity for open release rather than arthroscopic or conservative treatment; payers often deny without documented conservative treatment failure
Impact: Adequate diagnosis linkage and failed conservative treatment documentation prevents 30-40% of denials
For ASC settings, verify the procedure is on the approved ASC payment list and that the facility fee is properly coordinated with professional fee billing
Impact: Both rates are identical at $728.12 for 2025, but improper split billing can cause payment delays or duplicate claim edits
Review NCCI edits quarterly as bundling rules change; CPT 23406 has specific column 1/column 2 relationships that are updated regularly

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 23406 in 2025?

The 2025 Medicare national average reimbursement for CPT 23406 is $728.12 for both facility and non-facility settings. This is based on a total RVU of 22.51 and the 2025 conversion factor of 32.3465. Local Medicare Administrative Contractors may have slight geographic variations based on locality adjustments.

How many RVUs is CPT code 23406 worth?

CPT 23406 carries 22.51 total RVUs, broken down as 11.01 work RVUs, 9.94 practice expense RVUs (both facility and non-facility), and 1.56 malpractice RVUs. The high work RVU reflects the significant surgical effort and complexity of the procedure.

Can CPT 23406 be billed with rotator cuff repair codes?

CPT 23406 may be billed with rotator cuff repair codes if the tendon/muscle release is a distinct procedure performed through a separate incision or in a distinctly different anatomic area. However, this combination is subject to NCCI edits and typically requires modifier 59 with detailed documentation showing the procedures were separate and not integral to each other. Many payers will bundle these unless clear separation is documented.

What diagnosis codes support medical necessity for CPT 23406?

Common supporting diagnosis codes include M24.511-M24.512 (contracture of shoulder), M75.0 (adhesive capsulitis), M25.611-M25.612 (stiffness of shoulder), G80.x (cerebral palsy with contracture), S43.xxx (sequela of shoulder injury), and M24.61x (ankylosis of shoulder). Documentation must show the contracture significantly limits function and has failed conservative management.

Is CPT 23406 an inpatient or outpatient procedure?

CPT 23406 can be performed in either inpatient or outpatient settings. The 2025 Medicare rates are identical ($728.12) for both facility and non-facility settings. The decision for inpatient versus outpatient is based on patient complexity, comorbidities, and medical necessity rather than reimbursement differences. Most cases are performed outpatient in hospital or ASC settings.

What is the global period for CPT 23406?

CPT 23406 has a 90-day global surgical period. This means all routine postoperative care for 90 days following the procedure is included in the surgical fee and cannot be billed separately. Only unrelated E/M services or complications requiring return to the OR can be billed separately during this period with appropriate modifiers.

Do I need prior authorization for CPT 23406?

Prior authorization requirements vary by payer and state. Most commercial payers and Medicare Advantage plans require prior authorization for CPT 23406 due to its surgical nature and high reimbursement. Traditional Medicare does not require prior authorization but does require medical necessity documentation. Always verify requirements with the specific payer before scheduling, as failure to obtain authorization will result in denial even if medically necessary.