Superficial soft-tissue biopsy of the shoulder area, performed through a small incision to obtain a tissue sample from structures at or just below the skin surface for pathologic analysis.

Verified May 8, 2026 · 7 sources ↓

Medicare: $231.47
Work RVU: 2.24
Global, days: 10
Region: Shoulder

Drawn from CMSAAPCFacultyHealthcareinspiredllc

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Location of the lesion — specify superficial (above deep fascia) versus deep; 23065 requires superficial documentation
Size and characteristics of the mass or target tissue sampled, including clinical indication (e.g., suspected malignancy, inflammatory condition, unexplained soft-tissue mass)
Operative note naming the tissue layer accessed and confirming no subfascial dissection was required
Pathology requisition and specimen labeling confirming tissue was sent for analysis
If biopsy precedes a more extensive resection at the same session, document that intraoperative pathologic diagnosis drove the decision to proceed
Laterality — left or right shoulder — to support LT/RT modifier use and payer adjudication

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 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 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 23065 describes an open biopsy of superficial soft tissue in the shoulder region — tissue accessible above the deep fascia. The surgeon makes a small incision, excises or samples the target tissue (a palpable mass, suspicious nodule, or area of indeterminate change), and sends the specimen to pathology. This is the superficial counterpart to 23066, which covers deep (subfascial or intramuscular) biopsy of the same region. If imaging guidance is used to localize the lesion, that component is billed separately.

The 10-day global period means routine wound checks through day 10 are bundled. Do not separately bill an E/M for incision inspection in that window unless a new, unrelated problem is addressed — and that requires modifier 24. If a more extensive excision (e.g., 23075 or 23076) follows the biopsy at the same session, the biopsy is separately reportable only when the pathologic result at the time of surgery determined whether to proceed with the larger procedure. If the biopsy was merely checking margins, it bundles. When separately reportable in a staged scenario, append modifier 58.

FNA codes (10004–10012, 10021) cannot be billed alongside 23065 for the same lesion at the same encounter — report only one biopsy code. The shoulder is treated as a single anatomic structure under NCCI policy; ipsilateral shoulder procedure pairs generally cannot be unbundled with a modifier unless specific NCCI exceptions apply.

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 (2.24) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (6.93) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.24
Practice expense RVU	4.34
Malpractice RVU	0.35
Total RVU	6.93
Medicare national rate	$231.47
Global period	10 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	$231.47
HOPD (APC 5072) Hospital outpatient department	$1,687.37
ASC (PI P3) Ambulatory surgical center (freestanding)	$145.68

Common denial reasons

The recurring reasons claims for CPT 23065 get rejected.

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

Billed with an FNA code (10004–10021) for the same lesion at the same encounter — only one biopsy code is payable per lesion per session
Depth documentation insufficient — note does not clearly confirm superficial (above fascia) access, triggering a code mismatch flag between 23065 and 23066
Biopsy bundled into a same-session excision (23075–23077) when intraoperative path was used only for margin assessment, not to determine whether to proceed
Missing or mismatched laterality modifier when payer requires LT or RT for shoulder procedures
E/M billed same day without modifier 25, triggering automatic bundling of the office visit into the procedure

Frequently asked questions

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

01What is the difference between 23065 and 23066?

23065 is for superficial soft-tissue biopsy of the shoulder — tissue above the deep fascia. 23066 covers deep (subfascial or intramuscular) biopsy. The operative note must confirm which fascial layer was accessed; using the wrong code is a common audit flag.

02Can I bill 23065 and an FNA code at the same session for the same lesion?

No. NCCI policy prohibits reporting an FNA code (10004–10021) alongside 23065 for the same lesion at the same encounter. If the FNA specimen was adequate, stop there. If it was inadequate and an open biopsy was then performed, report only one code — whichever describes the successful procedure.

03If I perform 23065 immediately before a wider excision at the same session, can I bill both?

Only if the intraoperative pathologic result determined whether to proceed with the more extensive procedure. Document that sequence explicitly. If pathology was used solely to check margins or confirm resectability, the biopsy bundles. When separately reportable and staged, append modifier 58 to the biopsy.

04Does 23065 require a laterality modifier?

Many payers require LT or RT for shoulder procedures. Append the appropriate modifier and confirm whether your payer requires it on claim lines. Omitting laterality is a common soft-tissue shoulder denial trigger.

05Can I bill an E/M on the same day as 23065?

Yes, but only if a separately identifiable evaluation and management service was performed. Append modifier 25 to the E/M. Without modifier 25, the visit bundles into the procedure under NCCI policy.

06What global period applies to 23065, and what does it include?

23065 carries a 10-day global period. Routine wound checks and dressing changes through day 10 are bundled. An E/M for an unrelated condition during that window needs modifier 24. A related return to the OR needs modifier 78.

07Why does 23065 show top billing by dermatology and internal medicine rather than orthopedics?

Superficial shoulder soft-tissue biopsies are often performed in office settings for skin and subcutaneous lesions by dermatologists or generalists. Orthopedic surgeons more commonly encounter deeper masses coded to 23066. Confirm your tissue depth documentation supports the code you're billing regardless of specialty.

Sources & references

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

Mira Scribe

Mira's AI scribe captures tissue depth (superficial versus subfascial), lesion size and location on the shoulder, the clinical indication driving the biopsy, and whether intraoperative pathology was used to guide a subsequent procedure in the same session. That depth confirmation prevents 23065-versus-23066 mismatches that trigger medical-necessity denials, and the intraoperative-path notation protects separate billing when a staged excision follows.

See how Mira captures CPT 23065 documentation