Open arthrotomy of the glenohumeral joint for exploration, drainage of fluid or infection, and/or removal of a foreign body.

Verified May 8, 2026 · 6 sources ↓

Medicare: $673.03
Total RVUs: 20.15
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCMdclarityFastrvuBedrockbilling

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the surgical approach by name (deltopectoral, superior, etc.) — operative notes that state 'standard approach' are audit flags.
Document the indication clearly: septic arthritis, loose body, foreign body, or failed nonoperative workup with imaging correlation.
Record the volume and character of any fluid drained (purulent, serosanguineous, hemarthrosis) and whether cultures were sent.
Identify any foreign body or loose body removed, including size, location within the joint, and method of extraction.
If modifier 22 is appended, include a distinct paragraph in the operative note describing the added complexity, estimated additional time, and the specific anatomical factors that complicated the procedure.
Laterality must be documented (left or right) to support modifiers LT or RT.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 23040 covers open incision into the glenohumeral joint to directly inspect the joint space, evacuate purulent fluid or hematoma, and remove loose bodies or foreign material. This is an open procedure — not arthroscopic. It is indicated when imaging fails to explain symptoms, when septic arthritis requires surgical drainage, or when a foreign body cannot be retrieved by other means. The 90-day global period means all routine post-op shoulder care through day 90 is bundled into the payment. Any E/M visit during that window for an unrelated condition requires modifier 24.

Site of service matters here. The HOPD payment is approximately double the ASC payment, so payers scrutinize facility choice. Document the medical necessity for the chosen setting. If the surgeon performed substantially more work than typical — dense adhesions, extensive debridement, prolonged irrigation — support modifier 22 with a detailed operative note paragraph quantifying the added time and complexity. Generic language like 'joint explored and irrigated' will not support an upward complexity claim.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.51
Practice expense RVU	8.68
Malpractice RVU	1.96
Total RVU	20.15
Medicare national rate	$673.03
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	$673.03
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 23040 get rejected.

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

Medical necessity not established — no imaging or prior conservative treatment documented before open surgical intervention.
Operative note lacks specificity on what was found and removed, causing payers to downcode or deny as not separately identifiable.
Modifier 22 appended without a supporting complexity narrative, triggering automatic denial or reduction to base reimbursement.
Laterality modifier missing when payer requires LT or RT for paired structures.
Bundling conflict when 23040 is billed same-day with an arthroscopic shoulder code — open and arthroscopic approaches to the same joint on the same day require modifier 59 or XS with strong documentation justifying both.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Is 23040 ever billed with an arthroscopic shoulder code on the same day?

It happens, but it requires strong justification. If the surgeon converted from arthroscopic to open during the same session, document the reason for conversion explicitly. Append modifier 59 or XS to the secondary code and expect payer scrutiny — some carriers will bundle and reduce without appeal.

02When does the 90-day global period start for 23040?

The global period starts on the day of surgery. Day 0 is the operative date. All routine shoulder post-op care through day 90 is bundled. Bill modifier 24 on any E/M for an unrelated problem during that window, and link it to a distinct ICD-10 diagnosis code.

03Can 23040 be billed bilaterally?

Yes, bilateral glenohumeral arthrotomy in one session is reported with modifier 50. Document bilateral indications separately for each shoulder in the operative note. Expect payers to apply a 150% payment rule — the second side is typically reimbursed at 50% of the first.

04What ICD-10 codes typically pair with 23040?

Common pairings include M00.x1x (septic arthritis, shoulder), M24.01 (loose body in shoulder joint), and T14.x (foreign body injury codes depending on mechanism). The diagnosis must directly support the need for open surgical access rather than arthroscopic or percutaneous management.

05If the patient returns to the OR within the global period for ongoing infection, which modifier applies?

Use modifier 78 if the return procedure is related to the original surgery — for example, re-exploration for persistent septic arthritis. Modifier 79 applies only if the return procedure is entirely unrelated to the glenohumeral arthrotomy. Do not use 79 for complications of the index procedure.

06Does 23040 require prior authorization?

Most commercial payers require prior authorization for elective open shoulder surgery. Emergency drainage of septic arthritis may bypass standard auth requirements, but document the urgency and notify the payer within the required timeframe to avoid retrospective denial.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the surgical indication, joint approach, intraoperative findings (fluid character, loose body description, foreign body details), and any factors that increased procedural complexity directly from dictation. That prevents the most common audit flag for 23040: a vague operative note that lacks the specificity payers require to validate open glenohumeral surgery over a less invasive alternative.

See how Mira captures CPT 23040 documentation