CPT 23450Surgery

Repair shoulder capsule

CPT code 23450 covers surgical repair of the shoulder capsule, the connective tissue envelope that surrounds the shoulder joint and keeps it stable. This procedure is performed when the capsule is torn, stretched, or damaged, often due to dislocation or instability.

Showing rates for

National Average

Base Medicare rate

$932.87

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

13.7

PE RVU (NF)

12.35

MP RVU

2.79

Total RVU

28.84

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

NCCI bundling edits

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Billing tips

Clearly document whether the procedure was performed open versus arthroscopic; 23450 is specifically for OPEN repair, while arthroscopic capsular procedures use 29806
Impact: Prevents $400-600 payment difference and denial risk; incorrect code selection is a top audit trigger for shoulder procedures
Document the specific anatomic structures repaired (superior, inferior, anterior, or posterior capsule) and technique used (capsular shift, plication, advancement)
Impact: Supports medical necessity and prevents denials; detailed operative notes reduce audit risk by approximately 35%
When billing with rotator cuff repair (23412, 23420), ensure documentation supports separate procedures or use modifier 59 appropriately
Impact: Prevents bundling denials that can result in loss of $500-800 in additional reimbursement for the secondary procedure
Verify global period (90 days for 23450) and avoid billing E/M services during this period unless unrelated or with modifier 24
Impact: Improper global period billing results in automatic denials; modifier 24 can recover $150-300 for legitimate unrelated E/M visits
For ASC settings, verify the code status on Medicare's ASC approved list and state-specific regulations, as facility fees differ significantly
Impact: ASC payment rates can be 40-60% different than hospital outpatient rates; verify setting before scheduling
Link appropriate ICD-10 codes documenting instability pattern (M24.411-M24.419 for shoulder ligament laxity, S43.004A-S43.006A for dislocation)
Specific diagnosis coding reduces medical necessity denials by 25-30% and supports appropriate reimbursement

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23450 in 2025?

The 2025 Medicare national average reimbursement for CPT 23450 is $932.87 for both facility and non-facility settings. This is based on 28.84 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality and MAC jurisdiction.

What is the difference between CPT 23450 and 29806?

CPT 23450 describes open surgical repair of the shoulder capsule requiring a traditional incision and direct visualization, while CPT 29806 describes arthroscopic capsulorrhaphy performed through small portals using a camera. The surgical approach (open vs. arthroscopic) must be clearly documented in the operative report to support the correct code selection.

Can CPT 23450 be billed with rotator cuff repair codes?

Yes, but documentation must clearly support distinct procedures addressing separate pathology. When billing 23450 with rotator cuff repair codes (23412, 23420), the operative report should document both capsular instability/tear and rotator cuff pathology as separate conditions requiring separate repairs. Modifier 59 may be required to prevent bundling denials.

What diagnosis codes support medical necessity for CPT 23450?

Common supporting ICD-10 codes include M24.411-M24.419 (recurrent dislocation or ligament laxity of shoulder), S43.004A-S43.006A (shoulder dislocation), M75.30-M75.32 (shoulder capsulitis), and M24.811-M24.819 (other specific joint derangement). Documentation should show failed conservative treatment and functional impairment.

How many RVUs is CPT code 23450 worth in 2025?

CPT 23450 has 28.84 total RVUs in 2025, consisting of 13.7 work RVUs, 12.35 practice expense RVUs (both facility and non-facility), and 2.79 malpractice RVUs. This is a high-value surgical code reflecting the complexity and surgical time involved in open shoulder capsule repair.

What is the global period for CPT 23450?

CPT 23450 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. E/M services during this period are only separately billable if unrelated to the surgery (using modifier 24) or if complications require return to the operating room (modifier 78 or 79).

Is prior authorization required for CPT 23450?

Prior authorization requirements vary by payer. Medicare typically does not require prior authorization for CPT 23450, but many Medicare Advantage plans and commercial insurers do require it. Always verify payer-specific requirements before scheduling. Documentation of failed conservative treatment, imaging, and clinical instability is typically required for authorization approval.