Surgical removal of a deep (subfascial/intramuscular) soft-tissue tumor of the shoulder measuring 5 cm or greater in its greatest dimension.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $658.67
- Total RVUs
- 19.72
- Global, days
- 90
- Region
- Shoulder
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 6 cited references ↓
- Tumor depth confirmed as subfascial or intramuscular — state this explicitly in the operative note, not just 'deep dissection required'
- Measured tumor size of 5 cm or greater, documented intraoperatively and reconciled with pathology report
- Operative note describes the specific surgical approach and muscle layers traversed or reflected
- Preoperative imaging (MRI preferred) characterizing tumor depth, size, and relationship to neurovascular structures
- Pathology specimen submitted with laterality and anatomic site labeled; final path report retained in the record
- ICD-10 diagnosis code reflecting whether the tumor is benign, uncertain behavior, or malignant — this must match the pre-op working diagnosis or be updated post-pathology
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 6 cited references ↓
CPT 23073 covers open excision of a deep soft-tissue tumor in the shoulder area — subfascial or intramuscular — when the specimen measures 5 cm or more. These are substantial dissections: the surgeon must work through or beneath the muscle layer to achieve adequate margins, which is why the work RVU is nearly double that of its smaller-tumor counterpart. The 90-day global period applies, covering all routine post-op care through day 90.
Depth matters for code selection. If the tumor sits above the fascia, use 23071 (less than 5 cm) or 23075/23076 for superficial tumors — not 23073. Using 23073 on a superficial lesion is an audit target. Confirm depth in both the preoperative imaging read and the operative note.
Pathology submission is standard for tumors of this size. Document the specimen's measured dimensions — taken by the surgeon intraoperatively or confirmed on final pathology — because the 5 cm threshold is the billing threshold. A specimen that comes back at 4.8 cm on path creates a coding discrepancy you'll need to address.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 9.88 |
| Practice expense RVU | 7.57 |
| Malpractice RVU | 2.27 |
| Total RVU | 19.72 |
| Medicare national rate | $658.67 |
| 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 | $658.67 |
HOPD (APC 5073) Hospital outpatient department | $2,967.63 |
ASC (PI G2) Ambulatory surgical center (freestanding) | $1,248.36 |
Common denial reasons
The recurring reasons claims for CPT 23073 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Tumor size not documented at or above 5 cm — use 23071 if the lesion is deep but smaller than 5 cm
- Depth not substantiated in operative note; payers deny 23073 when the note is consistent with a superficial excision
- Missing or mismatched laterality — claims without LT or RT modifier are routinely flagged by commercial payers
- ICD-10 diagnosis code inconsistent with the procedure (e.g., a benign lipoma code paired with a malignant-tumor workup note)
- Unbundling of pathology handling or closure when those services are considered inclusive to the global excision
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What separates 23073 from 23071?
02Do I need LT or RT every time?
03Can I bill modifier 22 if the dissection was unusually complex?
04What happens if pathology returns a size below 5 cm?
05Is 23073 billable in an ASC setting?
06Can an assistant surgeon bill for this procedure?
07What is the global period for 23073?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02fastrvu.comhttps://fastrvu.com/cpt/23073
- 03mdclarity.comhttps://www.mdclarity.com/cpt-code/23073
- 04aapc.comhttps://www.aapc.com/codes/cpt-codes/23073
- 05findacode.comhttps://www.findacode.com/cpt/23073-cpt-code.html
- 06aaos.orghttps://www.aaos.org/quality/coding-and-reimbursement/
Mira AI Scribe
Mira's AI scribe captures tumor depth (subfascial vs. intramuscular), intraoperative measurement, the specific muscle layers dissected, and specimen laterality directly from dictation. This prevents the most common denial trigger for 23073 — an operative note that establishes size but fails to document subfascial depth, which downcodes the claim to a superficial excision code.
See how Mira captures CPT 23073 documentation