CPT 23412Surgery

Repair rotator cuff chronic

CPT code 23412 covers surgical repair of a chronic rotator cuff tear in the shoulder, typically performed when conservative treatments have failed and the tear has been present for an extended period.

Showing rates for

National Average

Base Medicare rate

$842.63

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

11.93

PE RVU (NF)

11.74

MP RVU

2.38

Total RVU

26.05

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Document chronicity clearly with specific timeframe, failed conservative treatment duration (minimum 6-12 weeks), and MRI findings indicating chronic features (muscle atrophy, fatty infiltration, tendon retraction)
Impact: Prevents downcoding to unlisted code or denial for medical necessity; protects full $842.63 reimbursement
Do NOT unbundle subacromial decompression (29826) when performed as integral part of rotator cuff repair; it is included in 23412
Impact: Prevents $300-400 takebacks and audit flags; unbundling is a top OIG target for orthopedic procedures
Bill facility rate ($842.63) when performed in ASC or hospital; non-facility rate also $842.63 for this code (no difference in 2025)
Impact: Ensures correct payment; facility/non-facility rates are identical for this surgical code
Use modifier 22 with comprehensive operative note detailing increased work for massive tears (>5cm), severe retraction, revision procedures, or significant technical difficulty
Impact: Can justify 20-50% payment increase ($168-$421 additional) but requires detailed documentation and often appeals process
Verify laterality modifier (LT/RT) on every claim before submission; implement hard stop in billing system
Impact: Prevents automatic denials accounting for 15-20% of initial claim rejections for this code
When performed with biceps tenodesis (23430) or distal clavicle excision (23120), ensure procedures are medically necessary and separately documented
Impact: Biceps tenodesis adds $380-450, distal clavicle excision adds $250-300 when properly documented and not bundled

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 23412?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the Medicare reimbursement rate for CPT 23412 in 2025?

The 2025 Medicare national average reimbursement for CPT 23412 is $842.63 for both facility and non-facility settings, based on 26.05 total RVUs and a conversion factor of 32.3465.

What is the difference between CPT 23412 and 23410 for rotator cuff repair?

CPT 23412 is for repair of a chronic rotator cuff tear with degenerative changes, while 23410 is for acute traumatic tears. Chronic tears involve long-standing degeneration, muscle atrophy, and failed conservative treatment, whereas acute tears result from recent injury.

Can I bill subacromial decompression separately with CPT 23412?

No, subacromial decompression (CPT 29826) is bundled into 23412 and should not be billed separately when performed as part of the rotator cuff repair. Unbundling these codes is a common audit trigger and will result in denials or recoupment.

How many RVUs is CPT code 23412 worth in 2025?

CPT 23412 has 26.05 total RVUs in 2025, consisting of 11.93 work RVUs, 11.74 practice expense RVUs, and 2.38 malpractice RVUs.

What documentation is required to support medical necessity for CPT 23412?

Required documentation includes: duration of symptoms (typically 3+ months), failed conservative treatment timeline (6-12 weeks minimum of PT/injections), pre-operative imaging confirming chronic tear, functional limitations, and evidence of chronic features like muscle atrophy or fatty infiltration on MRI.

When should I use modifier 22 with CPT 23412?

Use modifier 22 for significantly increased work due to massive tears (>5cm), severe retraction requiring extensive mobilization, revision surgery, extensive scarring, or significant muscle atrophy. Include detailed operative note documenting increased time (typically 50%+ above normal) and specific technical challenges encountered.

Is CPT 23412 a facility-only code or can it be performed in office?

CPT 23412 is a surgical procedure performed in facility settings (hospital outpatient, ASC, or inpatient hospital). While facility and non-facility rates are both $842.63 in 2025, this procedure is not performed in office settings due to surgical complexity and anesthesia requirements.