CPT 23931Surgery

I&d upr a/e bursa

CPT code 23931 covers the surgical drainage of an infected or inflamed fluid-filled sac (bursa) in the upper arm or elbow area. This minor surgical procedure relieves pain and removes infected fluid through a small incision.

Showing rates for

National Average

Base Medicare rate

$291.44

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

1.84

PE RVU (NF)

6.82

MP RVU

0.35

Total RVU

9.01

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

NCCI bundling edits

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Billing tips

Always verify place of service (POS) code accuracy - POS 11 (office) triggers non-facility rate of $291.44 while POS 22 (outpatient hospital) or 24 (ASC) triggers facility rate of $159.79
Impact: $131.65 reimbursement difference based solely on POS code; incorrect POS can result in significant underpayment or overpayment subject to recoupment
Do not confuse 23931 with 20605/20606 (aspiration/injection of intermediate joint/bursa) - I&D requires actual incision and drainage, not just needle aspiration
Impact: 20606 pays only $76.95 non-facility vs $291.44 for 23931; improper downcoding results in $214.49 loss per procedure
Bundle culture collection and Gram stain into the procedure - do not separately bill 87070 (culture) or 87205 (Gram stain) when performed as part of the I&D
Impact: Attempting to bill these separately will result in denial and potential audit flags; these are considered integral to the surgical procedure
Link appropriate ICD-10 codes indicating infection (M70.2x for olecranon bursitis, M71.1x for other bursal abscess) to establish medical necessity and prevent denials
Impact: Generic bursitis codes without infection specification may trigger denial for lack of medical necessity; proper coding supports full reimbursement
Document whether procedure was performed with local anesthesia, regional block, or MAC/general - anesthesia type affects facility coding and may impact total reimbursement when separately billed by anesthesia
Impact: Clear documentation prevents disputes over anesthesia billing; local anesthesia only may allow office-based procedure with higher non-facility rate
For recurrent bursitis requiring repeat I&D within 10 days, append modifier 76 (repeat procedure by same physician) or 78 (return to OR) as appropriate to avoid global period bundling

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23931 in 2025?

The 2025 Medicare national average reimbursement for CPT 23931 is $291.44 for non-facility settings (physician office) and $159.79 for facility settings (hospital outpatient or ASC). The $131.65 difference reflects facility overhead costs covered separately in facility settings.

What is the difference between CPT 23931 and 20606 for bursa drainage?

CPT 23931 requires surgical incision and drainage with open access to the bursa, while 20606 is percutaneous aspiration using only a needle. Code 23931 is appropriate for septic bursitis requiring incision, drainage, and irrigation, whereas 20606 is for simple needle aspiration or injection. The reimbursement difference is substantial: $291.44 vs $76.95 non-facility.

How many RVUs is CPT code 23931 worth in 2025?

CPT 23931 has a total of 9.01 RVUs in 2025, consisting of 1.84 work RVUs, 6.82 practice expense RVUs (non-facility), 2.75 practice expense RVUs (facility), and 0.35 malpractice RVUs. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

Can I bill an E/M visit with CPT 23931 on the same day?

Yes, you can bill a separately identifiable E/M service on the same day as 23931 by appending modifier 25 to the E/M code. The E/M must represent a significant, separately identifiable service beyond the usual pre-procedure evaluation, such as initial assessment of a new problem that led to the decision for drainage. Documentation must clearly support the separate nature of the E/M service.

What diagnosis codes support medical necessity for CPT 23931?

Primary diagnosis codes include M70.20-M70.23 (olecranon bursitis, unspecified or by laterality), M71.10-M71.12 (other bursal abscess), and specific infection codes like L02.3 (cutaneous abscess of limb) or M71.00-M71.02 (abscess of bursa). The diagnosis must indicate infection or inflammatory condition requiring surgical drainage rather than simple inflammation treatable conservatively.

Does CPT 23931 have a global period?

Yes, CPT 23931 has a 10-day global period. This means routine postoperative care for 10 days following the procedure is included in the reimbursement. Any complications requiring return to the operating room during this period require modifier 78, while unrelated procedures require modifier 79 to receive separate payment.

What modifiers are most commonly used with CPT 23931?

The most common modifiers are LT/RT (laterality - required for proper claim processing), modifier 25 (separate E/M service same day), modifier 50 (bilateral procedure), modifier 59 (distinct procedural service), and modifier 78 (return to OR during global period). Laterality modifiers are mandatory, while others are used based on specific clinical circumstances to ensure proper reimbursement.