CPT 23802Surgery

Arthrd glenohumeral jt w/grf

CPT 23802 covers surgical reconstruction of the shoulder joint (glenohumeral joint) using a graft, typically performed to restore function in patients with severe arthritis or joint damage. This is a major reconstructive procedure that replaces or repairs damaged shoulder joint surfaces.

Showing rates for

National Average

Base Medicare rate

$1,263.78

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

18.42

PE RVU (NF)

16.89

MP RVU

3.76

Total RVU

39.07

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

NCCI bundling edits

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Billing tips

Document graft source explicitly (autograft vs. allograft) and harvest site if autograft used
Impact: Failure to document graft type and source can trigger medical necessity denials resulting in $1,263.78 payment loss; separate code 20900-20902 may apply for graft harvest
Verify prior authorization before surgery as most payers require pre-certification for shoulder arthrodesis
Impact: Lack of pre-authorization can result in complete claim denial; retroactive authorization rarely granted for elective procedures
Append modifier 22 with detailed operative note when bone loss exceeds 50% or operative time exceeds typical by 30+ minutes
Impact: Properly documented modifier 22 claims can increase reimbursement by $250-$380 above standard $1,263.78 rate
Bill in facility setting when appropriate as both facility and non-facility rates are identical at $1,263.78
Impact: No financial differential, but facility coding ensures proper place of service coding and prevents claim rejections
Code separately for hardware removal if performed during same session using modifier 59
Impact: Hardware removal (20680) can add $200-$400 when medically necessary and properly documented as distinct procedure
Document failed conservative management including injections, physical therapy, and medication trials over minimum 6-month period
Impact: Inadequate documentation of conservative treatment failure is the leading cause of medical necessity denials for this high-value procedure

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23802 in 2025?

The 2025 Medicare national average reimbursement for CPT 23802 is $1,263.78 for both facility and non-facility settings, based on 39.07 total RVUs and the conversion factor of 32.3465.

What does CPT code 23802 include?

CPT 23802 includes arthrodesis (surgical fusion) of the glenohumeral (shoulder) joint with graft material. This covers joint preparation, graft placement (autograft or allograft), fixation, and wound closure. Graft harvest from a separate site may be coded separately.

Is CPT 23802 an inpatient or outpatient procedure?

CPT 23802 is typically performed as an inpatient hospital procedure due to the complexity and postoperative care requirements, though some cases may be performed in hospital outpatient or ASC settings depending on patient health status and payer policies.

What modifiers are required when billing CPT 23802?

Laterality modifiers LT (left) or RT (right) are mandatory for CPT 23802. Additional modifiers may include 22 (increased procedural services), 62 (co-surgeons), 78 (return to OR), or 80 (assistant surgeon) depending on specific circumstances.

How many RVUs is CPT 23802 worth in 2025?

CPT 23802 has 39.07 total RVUs in 2025, consisting of 18.42 work RVUs, 16.89 practice expense RVUs (both facility and non-facility), and 3.76 malpractice RVUs, making it a high-value orthopedic procedure.

What is the global period for CPT 23802?

CPT 23802 has a 90-day global surgical period, meaning all routine postoperative care for 90 days following surgery is included in the reimbursement and cannot be billed separately. Complications requiring return to OR may be separately billable with appropriate modifiers.

Can CPT 23802 be billed with shoulder arthroplasty codes?

No, CPT 23802 (shoulder arthrodesis/fusion) should not be billed with shoulder arthroplasty codes (23470-23472) as these are mutually exclusive procedures - fusion permanently eliminates joint motion while arthroplasty preserves it. Billing both together will result in bundling denials.