CPT 23415Surgery

Release of shoulder ligament

CPT code 23415 covers a surgical procedure to release tight or scarred ligaments in the shoulder that limit movement. This is typically performed to restore range of motion after injury, surgery, or conditions causing shoulder stiffness.

Showing rates for

National Average

Base Medicare rate

$696.42

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

9.23

PE RVU (NF)

10.41

MP RVU

1.89

Total RVU

21.53

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

NCCI bundling edits

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Billing tips

Always verify that conservative treatment (physical therapy, injections) is documented for at least 3-6 months prior to surgery
Impact: Medical necessity denials are common without documented failed conservative care; can result in complete denial of $696.42 payment
Document specific ligaments released in operative report (coracohumeral, superior glenohumeral, rotator interval, anterior/posterior capsule)
Impact: Vague documentation increases audit risk and can trigger downcoding or denial; specific anatomical documentation supports the 9.23 work RVUs
Do not bill 23415 with 29827 (arthroscopic shoulder surgery with rotator cuff repair) without modifier 59 and clear documentation of separate anatomical structures
Impact: High bundling risk; improper billing can result in denial of the lesser-valued code and potential recoupment of $696.42
Verify payer-specific policies on arthroscopic versus open approach; some payers may require different codes for arthroscopic capsular release
Impact: Some commercial payers prefer code 29825 for arthroscopic approach; using incorrect code may delay payment by 30-45 days during appeals
Capture pre-operative range of motion measurements and post-operative improvement goals in documentation
Impact: Strengthens medical necessity; reduces audit risk (current audit risk level is Medium) and supports full payment of 21.53 total RVUs
For ASC settings, ensure facility also bills appropriate C-code and verify patient met ASC eligibility criteria
Impact: Mismatched professional and facility coding can trigger payer audits; facility and professional rates are identical at $696.42, but facility billing errors can delay physician payment

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23415 in 2025?

The 2025 Medicare national average reimbursement for CPT 23415 is $696.42 for both facility and non-facility settings. This is based on 21.53 total RVUs multiplied by the 2025 conversion factor of 32.3465.

Can CPT 23415 be billed with rotator cuff repair codes?

Yes, but with caution. CPT 23415 can be billed with rotator cuff repair codes like 29827 when procedures are performed on distinct anatomical structures, but modifier 59 is typically required. Documentation must clearly show ligament/capsular release was separate from the rotator cuff repair to avoid bundling denials.

What is the difference between CPT 23415 and 29825?

CPT 23415 describes release of shoulder ligaments and can be performed via open or arthroscopic approach, while 29825 specifically describes arthroscopic shoulder surgery with lysis and resection of adhesions, with or without manipulation. Some payers prefer 29825 for arthroscopic capsular release, so verify payer-specific policies.

How much conservative treatment is required before billing 23415?

While not explicitly stated in CPT guidelines, most payers require documentation of at least 3-6 months of failed conservative treatment including physical therapy and often corticosteroid injections before approving surgical ligament release for adhesive capsulitis or shoulder contracture.

What modifiers are required for CPT code 23415?

Laterality modifiers (LT or RT) are required for every claim. Additional modifiers may include 50 for bilateral procedures, 59 for distinct procedural services when billed with other shoulder codes, or 22 for increased procedural services when significantly greater complexity is documented.

What are the work RVUs for CPT 23415?

CPT 23415 has 9.23 work RVUs in 2025, with practice expense RVUs of 10.41 and malpractice RVUs of 1.89, totaling 21.53 RVUs. These values are identical for both facility and non-facility settings.

What diagnosis codes support medical necessity for 23415?

Common supporting diagnosis codes include M75.00 (adhesive capsulitis of unspecified shoulder), M75.01/M75.02 (adhesive capsulitis of right/left shoulder), M24.611/M24.612 (contracture of right/left shoulder), and M25.611/M25.612 (stiffness of right/left shoulder). Documentation must demonstrate functional impairment and failed conservative care.