CPT 23440Surgery

Remove/transplant tendon

CPT 23440 covers surgical procedures where a surgeon removes a damaged tendon from the shoulder area or transplants a tendon from another location to restore shoulder function. This is typically performed to repair rotator cuff injuries or restore movement after severe shoulder trauma.

Showing rates for

National Average

Base Medicare rate

$748.82

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

10.64

PE RVU (NF)

10.37

MP RVU

2.14

Total RVU

23.15

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

NCCI bundling edits

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Billing tips

Clearly document whether procedure is a removal (excision) versus transplant (transfer/graft) in operative report, as this affects medical necessity justification
Impact: Prevents $748.82 denial for unclear procedure intent; CPT 23440 covers both but requires specific documentation
When billing tendon transplant, document donor site location, graft type (autograft vs allograft), and fixation method to support complexity
Impact: Supports modifier 22 claims for increased complexity, potentially adding $149.76-$299.53 to reimbursement
Verify LCD/NCD policies for shoulder tendon procedures in your MAC jurisdiction before surgery; some require prior authorization
Impact: Prevents 100% payment denial; preauthorization denials are difficult to appeal retroactively
Bill facility versus non-facility rate appropriately based on place of service; both rates are identical at $748.82 for CPT 23440
Impact: Unlike many codes, 23440 has matching facility/non-facility rates; POS code accuracy still critical for other bundled services
Do not bundle arthroscopic debridement (29822-29824) performed at same session; these are considered distinct when documented separately
Impact: Recovers additional $300-$600 when properly documented with modifier 59 on the arthroscopic code
For tendon transfers, ensure diagnosis code supports medical necessity (irreparable tear, failed conservative treatment) to avoid LCD denials
Impact: Medicare LCD compliance prevents denials; average appeal costs $200-$400 in staff time per claim

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23440 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 23440 is $748.82 for both facility and non-facility settings. This is based on 23.15 total RVUs multiplied by the 2025 conversion factor of 32.3465.

How many RVUs is CPT code 23440 worth?

CPT 23440 has a total of 23.15 RVUs for 2025, comprised of 10.64 work RVUs, 10.37 practice expense RVUs (both facility and non-facility), and 2.14 malpractice RVUs.

Does CPT 23440 cover both tendon removal and tendon transplant?

Yes, CPT 23440 covers both the removal (excision) of a shoulder tendon and the transplantation of a tendon. The operative report must clearly document which procedure was performed and the specific tendon(s) involved to establish medical necessity.

Can CPT 23440 be billed with rotator cuff repair codes?

This depends on NCCI edits and the specific procedures performed. If 23440 involves a distinct tendon or separate anatomical area from the rotator cuff repair, it may be billable with modifier 59. However, many payers bundle these services, so documentation must clearly show separate, distinct procedures to avoid denial.

What modifiers are required when billing CPT 23440?

Laterality modifiers (LT or RT) are required for every claim to specify which shoulder was treated. Additional modifiers may include 22 for increased complexity, 50 for bilateral procedures, 59 for distinct procedural services, or 78 for related procedures during the postoperative period.

What documentation is needed to support medical necessity for CPT 23440?

Required documentation includes preoperative imaging (MRI or ultrasound) showing tendon pathology, clinical notes documenting failed conservative treatment (minimum 6-12 weeks of physical therapy or other non-surgical interventions), specialist evaluation confirming surgical indication, and a detailed operative report describing the tendon condition and procedure performed.

Is prior authorization required for CPT 23440 tendon procedures?

Prior authorization requirements vary by payer and MAC jurisdiction. Many Medicare Administrative Contractors and commercial payers require preauthorization for shoulder tendon procedures due to the high reimbursement value. Always verify LCD/NCD policies and payer-specific requirements before scheduling surgery to avoid claim denials.