Open arthrotomy of the acromioclavicular or sternoclavicular joint for exploration, drainage, or removal of a foreign body or loose material.

Verified May 8, 2026 · 7 sources ↓

Medicare: $543.10
Total RVUs: 16.26
Global, days: 90
Region: Shoulder

Drawn from CMSAbosHealthcareinspiredllcAAPC

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify which joint was opened: acromioclavicular or sternoclavicular — do not document generically as 'shoulder joint'.
Describe the intraoperative findings (loose bodies, cartilage fragments, infection, foreign material) that justified open arthrotomy.
Document the surgical approach and confirm open (not arthroscopic) technique was used.
If a diagnostic arthroscopy preceded the open procedure, document that findings from the scope directly drove the decision to open, and whether staging was planned.
Medical necessity must be supported by preoperative imaging, prior conservative treatment, or clinical findings consistent with the diagnosis code used.
For bilateral or multi-joint procedures, document each anatomic site separately with laterality.

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 25 Significant separate E/M 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 23044 covers an open incision into the acromioclavicular (AC) or sternoclavicular (SC) joint to inspect the joint interior, drain fluid or infection, and remove loose bodies such as cartilage fragments or foreign material. This is an open procedure — not arthroscopic — and carries a 90-day global period. All routine post-op care through day 90 is bundled. Anything unrelated to the joint incision during that window requires modifier 24 or 25.

The AC and SC joints are distinct anatomic sites. If both joints require open arthrotomy at the same operative session, document each site explicitly and apply modifiers LT/RT as appropriate. Do not conflate 23044 with 23040 (glenohumeral joint arthrotomy) — payers and auditors treat them as separate code families.

If a diagnostic arthroscopy precedes this open procedure and findings from that scope directly drove the decision to open the joint, the arthroscopy may be separately reportable. Modifier 58 applies when the two are staged or planned. However, if the arthroscopy was performed solely to assess the surgical field for the open procedure, it is not separately billable under NCCI policy.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.4
Practice expense RVU	7.22
Malpractice RVU	1.64
Total RVU	16.26
Medicare national rate	$543.10
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	$543.10
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 23044 get rejected.

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

Non-specific joint documentation — operative notes that say 'shoulder joint' without specifying AC or SC trigger coding audits and downcoding.
Bundling of a same-session diagnostic arthroscopy without modifier 58 when arthroscopy preceded the open procedure and findings drove the decision to open.
Missing medical necessity linkage — no imaging or prior treatment failure in the record to justify open exploration over a less invasive approach.
Global period violations — billing routine post-op visits within the 90-day global without modifier 24 when unrelated to the original procedure.
Incorrect code selection — 23044 (AC or SC joint) confused with 23040 (glenohumeral joint), leading to payer mismatch with ICD-10 diagnosis codes.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What is the difference between CPT 23044 and 23040?

23040 covers open arthrotomy of the glenohumeral joint. 23044 covers the acromioclavicular or sternoclavicular joint. These are distinct anatomic structures and the codes are not interchangeable — ICD-10 diagnosis codes must align to the correct joint.

02Can I bill a diagnostic arthroscopy separately if it was performed before the open arthrotomy?

Yes, if the arthroscopy findings directly drove the decision to open the AC or SC joint. Attach modifier 58 to show the procedures were staged or planned. If the arthroscopy was done only to assess the surgical field for an already-planned open procedure, it is not separately billable under NCCI policy.

03What global period applies to 23044, and what does that mean for post-op billing?

23044 carries a 90-day global period. Routine post-op visits, wound care, and stitch removal within that window are bundled — do not bill them separately. Use modifier 24 for unrelated E&M visits and modifier 79 for unrelated procedures during the global period.

04Can 23044 be billed bilaterally if both AC and SC joints are opened in the same session?

The AC and SC joints are distinct anatomic sites, not bilateral versions of the same joint. Document each site separately and use modifier 59 or XS to distinguish separate anatomic sites if both are addressed. Apply LT and RT only when true laterality is relevant, such as bilateral AC joints.

05Do I need a different diagnosis code for each payer when billing 23044?

Your ICD-10 diagnosis must match the specific joint documented — AC or SC. Common diagnosis crosswalks include loose body in joint, joint infection, or foreign body codes. Mismatched CPT-to-diagnosis combinations are a leading denial trigger, so confirm payer-accepted diagnoses before submitting.

06Is 23044 an arthroscopic or open procedure?

23044 is an open procedure — it involves a direct incision into the joint. It is classified under incision procedures on the shoulder, not the arthroscopy code range. Billing it as equivalent to an arthroscopic approach is a coding error that auditors flag.

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 specific joint name (acromioclavicular vs. sternoclavicular), the intraoperative findings, the surgical approach, and whether a preceding arthroscopy was performed and staged. This prevents the most common audit flag for 23044 — an operative note that documents 'shoulder' without specifying the AC or SC joint, which triggers payer downcoding or outright denial.

See how Mira captures CPT 23044 documentation