CPT 23410Surgery

Repair rotator cuff acute

CPT 23410 covers surgical repair of a rotator cuff tear that occurred recently (acute injury), typically within weeks of the trauma. This is an open surgical procedure to reattach torn tendons in the shoulder.

Showing rates for

National Average

Base Medicare rate

$810.93

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

11.39

PE RVU (NF)

11.43

MP RVU

2.25

Total RVU

25.07

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

NCCI bundling edits

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Billing tips

Clearly document the acute nature of the injury with specific timeline (days or weeks since trauma) to differentiate from chronic repair (23412)
Impact: Prevents downcoding or denials; acute vs chronic distinction critical for medical necessity and correct code selection
Verify facility vs non-facility setting designation matches actual place of service; 23410 has identical rates ($810.93) for both settings in 2025
Impact: Ensures proper reimbursement and avoids place-of-service denials, though rates are equal for this code
When billing with arthroscopy or other shoulder procedures, review NCCI edits carefully; open rotator cuff repair typically bundles diagnostic arthroscopy
Impact: Prevents claim denials and recoupment demands; diagnostic scope (29805) bundles into 23410 without modifier
Document number of tendons repaired, tear size, and repair technique in operative report; if complexity warrants modifier 22, quantify additional time and difficulty
Impact: Supports modifier 22 appeals potentially worth $160-240 additional reimbursement; prevents upcoding allegations
Bill subacromial decompression (23130) separately only if performed through separate incision or clearly distinct from rotator cuff repair access
Impact: May add $200-300 when appropriately documented, but frequently denied if performed through same surgical approach
Capture all required ICD-10 codes including laterality, encounter type (initial, subsequent), and external cause codes for traumatic injuries
Impact: Incomplete diagnosis coding triggers denials or delays; external cause codes support acute injury medical necessity

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23410 in 2025?

The 2025 Medicare national average reimbursement for CPT 23410 is $810.93 for both facility and non-facility settings. This is based on 25.07 total RVUs (11.39 work RVU, 11.43 practice expense RVU, 2.25 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 23410 and 23412?

CPT 23410 covers repair of an acute rotator cuff tear (recent traumatic injury, typically within weeks), while 23412 describes repair of a chronic rotator cuff tear (longstanding degenerative tear). The distinction is based on injury timeline, tear characteristics on imaging, and presence of muscle atrophy or fatty infiltration indicating chronic pathology.

Can CPT 23410 be billed with arthroscopy codes?

Diagnostic shoulder arthroscopy (29805) is bundled into CPT 23410 and cannot be separately billed. However, distinct arthroscopic procedures addressing separate pathology (such as labral repair 29807) may be billable with modifier 59 if medically necessary and clearly documented as anatomically distinct from the open rotator cuff repair.

What modifiers are required when billing CPT 23410?

Laterality modifiers LT (left) or RT (right) are mandatory for CPT 23410. Additional modifiers may include 22 for increased complexity, 78 for return to OR during global period, 79 for unrelated procedure during global period, or 59 for distinct procedural service when billed with potentially bundled codes.

How many RVUs is CPT code 23410 worth?

CPT 23410 has 25.07 total RVUs in 2025, consisting of 11.39 work RVUs, 11.43 practice expense RVUs (same for facility and non-facility), and 2.25 malpractice RVUs. This represents a high-value surgical procedure reflecting significant physician work and practice resources.

What documentation is required to support medical necessity for CPT 23410?

Required documentation includes: specific traumatic injury date and mechanism, preoperative MRI or ultrasound confirming rotator cuff tear, clinical exam findings, timeline establishing acute nature of injury (typically within 3-12 weeks), operative report detailing tendons repaired and technique used, and laterality specification. Absence of chronic tear findings (muscle atrophy, fatty infiltration) supports acute coding.

Can CPT 23410 be billed bilaterally on the same day?

While anatomically possible, bilateral acute rotator cuff repairs on the same day are extremely rare due to the traumatic nature of acute tears. If performed bilaterally, use modifier 50 for bilateral procedure, which typically reimburses at 150% of the unilateral rate. Documentation must support medical necessity for bilateral acute repairs occurring simultaneously.