Open surgical removal of calcium deposits located beneath the deltoid muscle in the shoulder (subdeltoid region).
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $571.49
- Total RVUs
- 17.11
- Global, days
- 90
- Region
- Shoulder
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 6 cited references ↓
- Operative note must explicitly state 'open' approach — needle or arthroscopic techniques are not billable under 23000
- Describe the location of deposits (subdeltoid bursa, rotator cuff surface, tendon substance) and their gross appearance
- Document laterality (left, right, or bilateral) in both the operative note and the diagnosis
- If modifier 22 is used, quantify the additional work: dense, calcified, or adherent deposits with extended dissection time
- If a concurrent rotator cuff repair is performed, document that as a separate, distinct surgical step with its own description
- Preoperative imaging (X-ray or ultrasound) confirming calcific deposit should be in the record to support medical necessity
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 6 cited references ↓
CPT 23000 covers open excision of calcific deposits from the subdeltoid space of the shoulder — typically calcium hydroxyapatite accumulations associated with calcific tendinitis of the rotator cuff. The surgeon makes a direct incision, identifies the deposit, and evacuates the calcium material, which may be chalky, toothpaste-like, or hardened depending on disease phase. This is an open procedure; needle aspiration, barbotage, or arthroscopic lavage of calcific deposits are not reported with 23000.
The 90-day global period means all routine postoperative care — including wound checks, dressing changes, and suture removal — is bundled through day 90. If the surgeon elects to perform concomitant rotator cuff repair at the same session, that carries its own separately reportable code, but NCCI bundling rules apply and modifier use must be supported by distinct operative documentation. Same-day E/M visits require modifier 25 to be separately reimbursed.
Calcific tendinitis deposits are almost always unilateral, but bilateral presentation occurs. If both shoulders are addressed in the same operative session, append modifier 50 (or LT/RT on separate lines per payer preference). Laterality should always be specified in the claim and operative note — payers routinely flag shoulder procedures submitted without side designation.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 4.37 |
| Practice expense RVU | 12.04 |
| Malpractice RVU | 0.7 |
| Total RVU | 17.11 |
| Medicare national rate | $571.49 |
| Global period | 90 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 | $571.49 |
HOPD (APC 5073) Hospital outpatient department | $2,967.63 |
ASC (PI A2) Ambulatory surgical center (freestanding) | $1,248.36 |
Common denial reasons
The recurring reasons claims for CPT 23000 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing or ambiguous laterality — claims submitted without LT or RT are frequently rejected or pended
- Procedure coded as open (23000) when the operative note describes needle aspiration, barbotage, or arthroscopic lavage
- Lack of preoperative imaging documentation to establish medical necessity for surgical intervention
- Same-day E/M billed without modifier 25, resulting in bundling denial
- Bundling denial when a concurrent rotator cuff repair is reported without adequate documentation of a distinct surgical component
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01Can I bill 23000 for ultrasound-guided needle aspiration or barbotage of a calcific deposit?
02If the surgeon performs calcific deposit removal and a rotator cuff repair in the same session, how do I code it?
03What global period applies to 23000, and what does that mean for post-op visits?
04How do I bill if both shoulders are treated in the same operative session?
05When is modifier 22 justified for CPT 23000?
06Is there an HOPD vs. ASC payment difference for 23000, and does site of service affect coding?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/files/document/02-chapter2-ncci-medicare-policy-manual-2025finalcleanpdf.pdf
- 03aapc.comhttps://www.aapc.com/codes/cpt-codes/23000
- 04aaos.orghttps://www.aaos.org/quality/coding-and-reimbursement/aaos_coding_coverage/
- 05aaos.orghttps://www.aaos.org/globalassets/quality-and-practice-resources/coding-and-reimbursement/resident-guide/resident-guide_modifiers.pdf
- 06aaos.orghttps://www.aaos.org/globalassets/quality-and-practice-resources/coding-and-reimbursement/resident-guide/resident-guide-coding-reference-tools_what-is-ncci-mue_050125.pdf
Mira AI Scribe
Mira's AI scribe captures the surgical approach (open incision vs. needle or scope), deposit location within the subdeltoid space, gross deposit characteristics, and explicit laterality from the surgeon's dictation. It flags operative notes that omit the word 'open' or fail to specify side — the two documentation gaps most likely to trigger a medical necessity denial or payer pend on 23000 claims.
See how Mira captures CPT 23000 documentation