CPT 23920Surgery

Disarticulation shoulder

CPT code 23920 represents the complete surgical removal of the arm at the shoulder joint, separating the upper arm bone (humerus) from the shoulder blade (scapula). This major surgical procedure is typically performed when severe trauma, infection, or cancer makes limb salvage impossible.

Showing rates for

National Average

Base Medicare rate

$1,106.90

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

16.23

PE RVU (NF)

14.68

MP RVU

3.31

Total RVU

34.22

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

NCCI bundling edits

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Billing tips

Document medical necessity extensively including failed conservative treatments, imaging showing extent of pathology, and why limb salvage was not feasible
Impact: Prevents denial of entire $1106.90 claim; payers frequently challenge amputation necessity without exhaustive documentation
Consider modifier 22 with detailed operative report when extensive tumor margins require scapular resection, chest wall involvement, or brachial plexus reconstruction
Impact: Can increase reimbursement by $221-$553 (20-50%) with proper documentation of additional time and complexity
Bill separately for any nerve blocks, pain pumps, or post-operative pain management with appropriate CPT codes (64415, 64416) as these are not bundled
Impact: Additional $50-$150 in reimbursement for medically necessary pain control procedures performed
Ensure laterality modifier (RT/LT) is included on initial claim submission; this is a CMS requirement for all paired anatomic structures
Impact: Prevents automatic claim rejection and 14-21 day payment delay for resubmission
Code any concurrent vascular repair or reconstruction separately (35206, 35266) when performed by same surgeon if extensive vessel work beyond routine ligation
Impact: Additional $300-$800 depending on vascular complexity; use modifier 59 if necessary to bypass NCCI edits
For cancer patients, verify pre-authorization and coordinate with oncology team for proper diagnosis coding (C40.0x, C49.1x) to support medical necessity
Impact: Prevents denial of $1106.90 claim; cancer diagnosis codes have higher approval rates than trauma codes for elective cases

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23920 in 2025?

The 2025 Medicare national average reimbursement for CPT 23920 is $1106.90 for both facility and non-facility settings. This rate is based on 34.22 total RVUs (16.23 work RVU, 14.68 PE RVU, 3.31 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

What does CPT code 23920 include in the surgical procedure?

CPT 23920 includes complete disarticulation at the glenohumeral joint, removal of the entire upper extremity, ligation of major vessels (axillary artery and vein), identification and division of brachial plexus nerves, soft tissue dissection and contouring for stump closure, and primary wound closure. It does not include forequarter amputation (scapula removal).

Can I bill CPT 23920 with modifier 22 for increased complexity?

Yes, modifier 22 is appropriate when shoulder disarticulation involves significantly greater complexity such as extensive tumor resection, severe trauma with difficult tissue planes, revision after infection, or unexpected intraoperative complications requiring substantially more time and effort. Documentation must clearly quantify the additional work to justify increased reimbursement of 20-50%.

What is the difference between CPT 23920 and forequarter amputation?

CPT 23920 is shoulder disarticulation where the arm is removed at the glenohumeral joint but the scapula remains intact. Forequarter amputation (CPT 23900) involves removal of the entire upper extremity including the scapula and often the clavicle, representing a more extensive procedure with higher RVU values.

What documentation is required to support medical necessity for shoulder disarticulation?

Required documentation includes imaging demonstrating extent of pathology, documentation of failed limb salvage attempts or explanation why not feasible, detailed operative findings, pathology reports for oncologic cases, vascular studies showing non-reconstructable injury for trauma, and comprehensive medical record showing progressive disease or acute injury warranting amputation.

How many RVUs is CPT code 23920 worth in 2025?

CPT 23920 has 34.22 total RVUs in 2025, comprised of 16.23 work RVUs, 14.68 practice expense RVUs, and 3.31 malpractice RVUs. This high RVU value reflects the significant physician work, surgical complexity, and risks associated with major upper extremity amputation.

What are common reasons for denial of CPT 23920 claims?

Common denials include insufficient documentation of medical necessity, missing laterality modifiers (RT/LT), diagnosis codes not supporting amputation level, lack of documentation showing failed conservative management or limb salvage attempts, and insufficient operative notes when modifier 22 is appended. Each requires specific documentation in the appeal.