Surgical incision through the cortex of a shoulder-area bone to drain an abscess or debride infected bone, as in osteomyelitis.

Verified May 8, 2026 · 5 sources ↓

Medicare: $634.62
Work RVU: 8.93
Global, days: 90
Region: Shoulder

Drawn from CMSNIHAAPC

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 5 cited references ↓

Operative note must state that the bone cortex was incised — not just soft tissue or periosteum.
Document the specific infectious indication: osteomyelitis, bone abscess, or equivalent with culture or imaging correlation.
Record the shoulder-area bone involved (proximal humerus, clavicle, scapula) and laterality.
Note whether a drain was placed, what irrigation was performed, and the closure technique.
Pre-op imaging (X-ray, MRI, or CT) showing cortical involvement should be in the chart to support medical necessity.
Anesthesia type and intraoperative findings including extent of debridement should be documented explicitly.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 23035 covers an open surgical procedure in which the surgeon incises the outer cortex of a bone in the shoulder region to access and treat an infectious process — most commonly osteomyelitis or a bone abscess. The operative sequence involves exposing the bone through layered dissection, cutting through the cortex, debriding necrotic or infected tissue, irrigating the site, and closing with or without a drain left in place. This is not a simple I&D of superficial soft tissue; the code requires documented penetration of bone cortex.

The 90-day global period means all routine post-op visits, wound checks, and drain management through day 90 are bundled. Separate E&M visits during that window require modifier 24 to flag an unrelated diagnosis, or modifier 78 if the patient returns to the OR for a related complication such as persistent infection or hardware-adjacent debridement.

Diagnosis linkage is critical here. The claim should be supported by an ICD-10 code that specifically identifies the infectious etiology — laterality-specific osteomyelitis codes (e.g., M86 series) are expected. A generic musculoskeletal pain code will not justify a bone-cortex incision and will trigger medical necessity denials.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (8.93) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (19) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.93
Practice expense RVU	8.23
Malpractice RVU	1.84
Total RVU	19
Medicare national rate	$634.62
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	$634.62
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 23035 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Medical necessity denied when the diagnosis code is non-specific or lacks documented cortical bone involvement.
Bundling denial if a soft-tissue debridement or wound I&D code is billed same-day through the same surgical field without a distinct anatomic rationale.
Laterality mismatch between the ICD-10 code and the operative site triggers automated claim rejection.
Missing pre-authorization for inpatient or ASC setting when payer requires it for major surgical procedures.
Global period violation — post-op visit billed without modifier 24 when a separate E&M is attempted during the 90-day window.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Can 23035 be billed with a soft-tissue debridement code on the same day?

Only if the debridement is at a distinct anatomic site or through a separate incision. Billing both for work performed in the same surgical field through the same approach will trigger an NCCI bundling edit. Document separate sites explicitly if you intend to unbundle.

02What ICD-10 codes support 23035?

Laterality-specific codes from the M86 series (osteomyelitis) are the primary support. Use the most specific subtype available — acute, subacute, chronic, or other — with the correct shoulder-region site. A non-specific infection code alone is unlikely to satisfy medical necessity review.

03Is 23035 billable bilaterally in a single operative session?

Bilateral shoulder osteomyelitis is rare but not impossible. If both shoulders are operated on in one session, append modifier 50 and document bilateral involvement in the pre-op workup and operative note.

04What global period applies and what does it include?

23035 carries a 90-day global. That covers the day-before pre-op visit, the procedure, and all routine post-op care through day 90 — including wound checks, dressing changes, and drain removal. Unrelated E&M visits need modifier 24. A return to the OR for a related complication uses modifier 78.

05Can modifier 22 be used if the debridement was unusually extensive?

Yes, but only with solid documentation. The operative note must describe specific circumstances — e.g., multiloculated abscess, unusually large zone of necrotic cortex, or significantly prolonged operative time — that took the procedure substantially beyond the typical effort. Payers will request the op note on modifier 22 claims.

06Is pre-authorization typically required for 23035?

Most commercial payers require prior authorization for procedures with a 90-day global period performed in an ASC or inpatient setting. Verify payer-specific requirements before scheduling. Medicare does not require prior auth for this code, but LCD coverage criteria for infectious bone conditions may still apply.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the surgeon's dictation of bone cortex penetration, the infectious indication (osteomyelitis vs. abscess), the specific bone and laterality, debridement extent, irrigation volume, and drain placement. This prevents the most common audit flag for 23035: an operative note that documents soft-tissue dissection but never explicitly confirms cortical incision, which leaves the claim unsupported for the code level billed.

See how Mira captures CPT 23035 documentation