Excisional biopsy of deep soft tissue of the shoulder, including fascia and muscle layers, for diagnostic tissue sampling.

Verified May 8, 2026 · 7 sources ↓

Medicare: $625.60
Total RVUs: 18.73
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCNIHAoassnAAOS

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Preoperative diagnosis specifying the location and depth of the shoulder mass or lesion prompting biopsy
Operative note confirming the tissue was deep (fascial layer or below, including muscle) — not subcutaneous
Specimen description and laterality (right vs. left shoulder) documented in the operative report
Pathology report or pending pathology order tied to the excised specimen
Medical necessity narrative: why open excisional biopsy was required rather than needle or superficial biopsy
Any prior imaging (MRI, ultrasound) referenced in the note to support the decision to biopsy deep tissue

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 57 Decision for surgery 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 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 23066 describes an open biopsy of deep soft tissue in the shoulder region — tissue at or below the fascial layer, including intramuscular tissue. The surgeon identifies a suspicious lesion or mass, excises a tissue sample from the deep soft tissue, and submits it for pathologic evaluation to determine whether the tissue is benign, malignant, or otherwise abnormal. This is not a superficial or percutaneous needle biopsy; the depth and open surgical approach distinguish it from more superficial shoulder biopsy codes.

The 90-day global period applies. That covers the operative day, the day-before visit, and all routine follow-up through day 90. Separate E/M visits during that window require modifier 24 (established patient, unrelated) or modifier 25 (new problem, same day as procedure). Pathology interpretation is separately billable by the pathologist under the professional component and is not bundled into 23066.

Site-of-service matters here. The HOPD and ASC payments differ substantially — see the Site of Service comparison table. When the case moves from an office or ASC setting to a hospital outpatient department, reimbursement shifts accordingly. Document medical necessity for the chosen setting, especially if payer policy requires prior authorization for excisional biopsies in any facility setting.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4.19
Practice expense RVU	13.62
Malpractice RVU	0.92
Total RVU	18.73
Medicare national rate	$625.60
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	$625.60
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 23066 get rejected.

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

Insufficient documentation of tissue depth — payers deny when the note doesn't confirm the biopsy reached deep/fascial or muscle layers
Missing or mismatched laterality — billing without LT or RT modifier when the payer requires it triggers edits
Medical necessity not established — no imaging, clinical exam findings, or prior workup referenced to justify open excisional biopsy
Unbundling conflicts when 23066 is billed same-day with other shoulder procedures without modifier 59 or XS to establish distinct service
Global period violations — E/M or follow-up visits billed within the 90-day global without modifier 24 or 25

Frequently asked questions

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

01What distinguishes 23066 from a superficial shoulder biopsy code?

23066 requires that the biopsy reach deep soft tissue — at or below the fascial layer, including muscle. Subcutaneous or skin-level biopsies of the shoulder are coded elsewhere. The operative note must explicitly confirm the depth; 'biopsy of shoulder mass' alone won't support 23066 on audit.

02Does the 90-day global period apply to 23066?

Yes. The global is 090, covering the day before surgery, the operative day, and all routine postoperative care through day 90. Unrelated E/M visits in that window need modifier 24. Same-day E/M visits for a separate problem need modifier 25.

03Should LT or RT be appended to 23066?

Yes, for most payers. Append LT or RT to identify the operative shoulder. If both shoulders are biopsied in the same session, use modifier 50 and confirm the payer's bilateral payment policy — some require two line items with LT and RT instead.

04Can 23066 and a shoulder arthroscopy code be billed on the same day?

Only if they are clearly distinct procedures. Use modifier 59 or XS to indicate a separate service, and document why both were medically necessary and performed independently. NCCI bundling edits may still apply depending on the paired code — check the CMS NCCI PTP tables before billing.

05Is pathology interpretation bundled into 23066?

No. The surgeon's open biopsy is captured by 23066. The pathologist bills separately for specimen analysis under the appropriate pathology CPT code with modifier 26 (professional component) if applicable. These are distinct services by distinct providers.

06When is modifier 22 appropriate for 23066?

When the procedure required substantially more work than typical — for example, a lesion in an anatomically difficult location, extensive adhesions, or a significantly larger or more complex mass than anticipated. Document the specific factors that increased complexity; modifier 22 claims without supporting narrative are routinely denied or downward-adjusted.

Sources & references

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

Mira AI Scribe

The Mira AI Scribe captures tissue depth (fascial versus intramuscular), lesion size and location within the shoulder, laterality, and the surgeon's stated rationale for open excisional versus needle biopsy — directly from dictation. That prevents the most common denial trigger: an operative note that describes a biopsy without confirming deep tissue involvement, which auditors and payers treat as insufficient to support 23066 over a lower-level superficial biopsy code.

See how Mira captures CPT 23066 documentation