Unlisted code for an open or percutaneous shoulder procedure that no listed shoulder code or Category III code describes.
- Medicare
- $0.00
- Work RVU
- 0
- Global, days
- Region
- Shoulder
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 2 cited references ↓
- Operative note confirming open or percutaneous approach
- Structures repaired or reconstructed and fixation used
- Why no listed shoulder or Category III code fits
- Comparison code with similar time and work
- Laterality and supporting imaging
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 2 cited references ↓
23929 covers open or percutaneous shoulder procedures with no matching code in the shoulder section. Arthroscopic shoulder procedures with no code go to 29999, not here. That split matters: a payer will deny a 23929 claim if the op note describes an arthroscopic case.
Common reasons it gets used include newer reconstructive techniques, unusual tendon transfers, or implant procedures that CPT has not caught up with. Check Category III codes first. Then check whether the work is really a listed procedure with a different graft or fixation choice, which does not justify an unlisted code.
No Medicare fee and a YYY global. Send the op note, a cover letter, and a comparison code (for shoulder, often a listed open repair with similar time). Laterality modifiers help the payer match the claim to imaging and prior authorization. Do not add 22. If the case was harder than the comparison code, say so in the letter and let the payer price it from there.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 0 |
| Practice expense RVU | 0 |
| Malpractice RVU | 0 |
| Total RVU | 0 |
| Medicare national rate | $0.00 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $0.00 |
HOPD (APC 5111) Hospital outpatient department | $252.01 |
Common denial reasons
The recurring reasons claims for CPT 23929 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Procedure was arthroscopic and belongs under 29999
- A listed shoulder code describes the service
- Category III code exists
- Missing laterality or procedure description
- No prior authorization
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 2 cited references ↓
01What is the difference between 23929 and 29999 for shoulder?
02How is CPT 23929 priced?
03Should I use RT or LT with 23929?
Sources & references
Editorial content was developed using the following public sources.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c12.pdf
Mira Scribe
Mira Scribe notes the approach, side, and each step of the repair, so coders can tell open from arthroscopic work and pick the right unlisted code.
See how Mira captures CPT 23929 documentation