CPT 23930Surgery

I&d upr a/e dp absc/hmtma

CPT 23930 covers the surgical procedure to drain a deep abscess or blood collection (hematoma) in the upper arm or elbow area. This requires making an incision to reach the deep infection or fluid collection beneath the muscle layers.

Showing rates for

National Average

Base Medicare rate

$348.70

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

2.99

PE RVU (NF)

7.16

MP RVU

0.63

Total RVU

10.78

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

NCCI bundling edits

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Billing tips

Confirm depth of abscess/hematoma with imaging documentation (ultrasound, CT, MRI) before billing 23930 versus superficial codes 10060-10061
Impact: Prevents downcoding to 10061 which pays only $142.48, resulting in $206 loss per procedure
Bill in non-facility setting when performed in physician office or independent facility to capture the $348.70 rate versus $213.81 facility rate
Impact: Generates $134.89 additional revenue per procedure when site-of-service permits non-facility billing
Document dissection through muscle or deep fascia explicitly in operative note to substantiate 23930 over intermediate codes
Impact: Audit-proof documentation prevents recoupment demands; even one successful appeal saves $348.70 plus administrative costs
Consider billing 23930 with modifier 78 for recurrent drainage within global period rather than using no-charge code
Impact: Captures approximately $244 for necessary return procedures rather than writing off the service entirely
When draining multiple discrete deep abscesses in the same anatomic region, bill 23930 for first and append modifier 59 to second with clear documentation
Impact: Secures payment for second drainage (full $348.70 with modifier 59) that would otherwise bundle to zero reimbursement
Verify laterality modifier (LT/RT) is appended on every claim to prevent processing delays and information request denials
Impact: Reduces claim rejection rate and accelerates payment by 7-14 days average, improving cash flow

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Frequently asked questions

What is the difference between CPT 23930 and simple I&D codes 10060-10061?

CPT 23930 is for deep abscesses or hematomas requiring dissection through muscle or deep fascia in the upper arm/elbow, while 10060-10061 are for simple or complicated superficial abscesses involving only skin and subcutaneous tissue. The depth of the collection and extent of surgical dissection determine the correct code, with 23930 reimbursing $348.70 versus $142.48 for 10061.

How much does Medicare pay for CPT 23930 in 2025?

Medicare pays $348.70 for CPT 23930 when performed in a non-facility setting and $213.81 in a facility setting under the 2025 Physician Fee Schedule. These rates represent national averages and may vary by locality based on geographic practice cost indices.

Can CPT 23930 be billed with an E/M visit on the same day?

Yes, an E/M service can be billed with CPT 23930 on the same day if a significant, separately identifiable evaluation is performed and documented. Modifier 25 must be appended to the E/M code to indicate the service was above and beyond the usual pre-procedure assessment.

What documentation is needed to support billing CPT 23930?

Documentation must include pre-procedure imaging confirming a deep collection, operative note describing dissection through deep fascia or muscle, specific anatomic location in the upper arm or elbow, volume and character of drainage, placement of any drains, and post-procedure wound management plan including cultures sent.

What are the work RVUs for CPT code 23930?

CPT 23930 has 2.99 work RVUs, 7.16 practice expense RVUs (non-facility), 2.99 practice expense RVUs (facility), and 0.63 malpractice RVUs, for a total of 10.78 RVUs in the non-facility setting based on the 2025 Medicare Physician Fee Schedule.

Which medical specialties typically bill CPT 23930?

CPT 23930 is most commonly billed by orthopedic surgeons, general surgeons, hand surgeons, trauma surgeons, and plastic surgeons who treat deep soft tissue infections and hematomas of the upper extremity. It may also be billed by emergency medicine physicians performing the procedure in hospital settings.

What CPT codes are commonly billed together with 23930?

Common companion codes include culture and sensitivity testing (87070-87077), wound exploration codes if injury-related (20103), imaging studies like ultrasound (76881) or MRI (73218-73220), and appropriate E/M codes with modifier 25. Debridement codes may be billed separately if extensive tissue removal beyond drainage is required.