Excision of a subcutaneous soft tissue tumor or mass in the shoulder area measuring 3 cm or greater in diameter.

Verified May 8, 2026 · 5 sources ↓

Medicare: $407.16
Total RVUs: 12.19
Global, days: 90
Region: Shoulder

Drawn from CMSEmednyCdnPayerprice

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Measured lesion size in centimeters documented in the operative note — 3 cm or greater required for 23071
Depth of tumor explicitly stated as subcutaneous; subfascial or intramuscular depth shifts the code to 23073 or 23076
Laterality documented (left vs. right shoulder) to support LT/RT modifier
Pre-operative imaging or clinical findings establishing the lesion as a distinct soft tissue mass, not a skin lesion
Pathology report ordered and linked to confirm specimen disposition and support medical necessity
Operative note describing the surgical approach, extent of dissection, and final defect management

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 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 5 cited references ↓

CPT 23071 covers surgical removal of a subcutaneous soft tissue tumor or lesion in the shoulder region when the lesion measures 3 cm or more. The code is depth-specific — subcutaneous only. If the tumor is subfascial (e.g., intramuscular) and 5 cm or greater, bill 23073 instead. For subcutaneous shoulder tumors under 3 cm, use 23075. Getting the size threshold and depth wrong is the single most common miscoding error in this code family.

This code carries a 90-day global period. All routine postoperative care from the day before surgery through day 90 is bundled. Separate E/M visits during that window require modifier 24 (unrelated problem) or 25 (significant, separately identifiable same-day E/M before a procedure). A return to the OR for a related complication in that global period bills with modifier 78; an unrelated procedure in the same period uses modifier 79.

Laterality matters for clean claim submission. Append LT or RT to identify the operative shoulder. If both shoulders are treated in the same session — uncommon but possible — append modifier 50 and bill a single line. Pathology on the excised specimen is separately billable and not bundled into 23071.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.76
Practice expense RVU	5.06
Malpractice RVU	1.37
Total RVU	12.19
Medicare national rate	$407.16
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	$407.16
HOPD (APC 5072) Hospital outpatient department	$1,687.37
ASC (PI G2) Ambulatory surgical center (freestanding)	$742.04

Common denial reasons

The recurring reasons claims for CPT 23071 get rejected.

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

Size not documented — no measured dimension in the operative note to confirm the 3 cm threshold
Depth mismatch — operative note describes subfascial or intramuscular dissection but 23071 (subcutaneous) was billed
Laterality modifier missing — payers increasingly require LT or RT on shoulder codes or reject the claim
Bundling conflict when skin excision codes are billed same-day without modifier 59 or XS to establish a distinct anatomical site
Medical necessity denied when the lesion is described only as a 'lipoma' without supporting documentation of symptoms, growth, or functional impairment

Frequently asked questions

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

01What's the difference between 23071 and 23075?

Both cover subcutaneous shoulder soft tissue excisions, but 23071 is for tumors 3 cm or greater and 23075 is for tumors under 3 cm. Bill based on the measured specimen or pre-excision size documented in the operative note — not an estimate.

02When should I use 23073 instead of 23071?

Use 23073 when the tumor is subfascial — for example, intramuscular — and measures 5 cm or greater. If the operative note documents dissection below the fascia, 23071 (subcutaneous) is the wrong code regardless of size.

03Is pathology bundled into 23071?

No. Surgical pathology is separately billable. Submit the appropriate pathology CPT code (e.g., 88304 or 88305) linked to the excised specimen. Do not bill 23071 and the pathology code on the same claim line.

04Can I bill an E/M on the same day as 23071?

Yes, if the E/M is significant and separately identifiable — append modifier 25 to the E/M code. During the 90-day global period, a postoperative E/M for an unrelated problem requires modifier 24. Routine post-op visits in the global window are not separately billable.

05How do I bill if the patient needs to return to the OR during the 90-day global for a complication of the original excision?

Bill the return-to-OR procedure with modifier 78 (unplanned return, related procedure, same global period). If the return procedure is unrelated to the original excision, use modifier 79 instead. Do not invert these two modifiers.

06Is 23071 performed in the ASC or office setting, and does site of service affect payment?

23071 is most commonly performed in an on-campus outpatient hospital or ASC setting. Site of service significantly affects payment — see the HOPD vs. ASC comparison on this page. Office-based excision of a lesion this size is uncommon and may face additional payer scrutiny.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures lesion size in centimeters, depth (subcutaneous vs. subfascial), operative shoulder (left/right), and approach from the surgeon's dictation — then flags the note if measured size or depth is absent before the claim is coded. That prevents the two most common 23071 denials: missing size documentation and depth-code mismatch.

See how Mira captures CPT 23071 documentation