Surgical removal of a subcutaneous soft tissue tumor of the shoulder area measuring less than 3 cm, including margins, at the time of excision.

Verified May 8, 2026 · 6 sources ↓

Medicare: $554.79
Work RVU: 4.1
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCFacsPalmetto GBAEmedny

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Tumor location documented as subcutaneous (not subfascial or intramuscular)
Measured greatest diameter of tumor plus excision margin recorded in the operative note at the time of excision
Operative note specifies the shoulder as the anatomic site
Pathology specimen submitted and requisition documented in the record
Anesthesia type (local vs. general) documented
Laterality documented (left, right, or bilateral)

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 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 6 cited references ↓

CPT 23075 covers open excision of a subcutaneous soft tissue tumor in the shoulder region when the tumor plus the margin required for complete excision measures less than 3 cm at its greatest diameter. Size is measured intraoperatively — tumor plus narrowest adequate margin — not from the preoperative imaging report. The code is subcutaneous only; subfascial (intramuscular) tumors under 5 cm go to 23076 regardless of size, and subcutaneous tumors at or above 3 cm go to 23071.

The procedure is performed in an outpatient hospital, ASC, or office setting. Pathology submission of the specimen is standard. The code carries a 90-day global period, so routine follow-up visits, wound checks, and suture removal through day 90 are bundled. Unrelated E/M services billed in that window require modifier 24; a significant, separately identifiable E/M on the day of surgery requires modifier 25.

Code selection hinges on two variables: anatomic depth (subcutaneous vs. subfascial) and specimen size (tumor plus margin). Operative notes that omit the measured size or document only the tumor without the margin are the leading driver of downcodes and audits. Document both dimensions explicitly.

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 (4.1) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (16.61) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.1
Practice expense RVU	11.59
Malpractice RVU	0.92
Total RVU	16.61
Medicare national rate	$554.79
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	$554.79
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 23075 get rejected.

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

Operative note fails to document measured tumor-plus-margin size, making code level unverifiable
Depth not specified — payer downcodes to a skin lesion code (e.g., 11402) when subcutaneous depth isn't clearly documented
Incorrect code level selected — tumor plus margin at or above 3 cm billed as 23075 instead of 23071
Unbundling denial when 23075 is billed alongside a skin lesion excision code for the same lesion without a valid modifier
Routine post-op visit billed separately within the 90-day global period without modifier 24

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01How is the 3 cm threshold measured for 23075?

Measure the greatest diameter of the tumor plus the narrowest margin required for complete excision, assessed at the time of surgery — not from the preoperative MRI or ultrasound. If that combined measurement is less than 3 cm, use 23075. At or above 3 cm, use 23071.

02What's the difference between 23075 and 23076?

Depth. 23075 is subcutaneous (above the fascia), less than 3 cm. 23076 is subfascial — intramuscular or below the fascia — less than 5 cm. If you're below the fascia, 23076 applies regardless of whether the tumor is smaller than 3 cm.

03Can 23075 be billed in an office setting?

Yes. The procedure is performed in office, ASC, and outpatient hospital settings. Site of service affects your payment rate — non-facility (office) reimbursement is higher than the facility rate. See the Site of Service comparison on this page.

04What modifier do I use if I excise two separate subcutaneous shoulder tumors on the same day?

If both tumors are in the same shoulder and are distinct lesions, bill 23075 twice with modifier 59 (or XS if the payer follows NCCI subset modifier guidance) on the second unit. Document each lesion's location, size, and separate incision in the operative note.

05Does the 90-day global period affect billing if the patient returns for an unrelated shoulder problem?

Yes. Any E/M or procedure during the 90-day global that is unrelated to the excision needs modifier 79 (unrelated procedure) or modifier 24 (unrelated E/M). If the return is for a complication or related issue requiring a return to the OR, use modifier 78.

06Should I use 23075 or a skin lesion code like 11402 if the pathology comes back as a lipoma?

Code selection is based on what was performed and documented, not the final diagnosis. If the operative note documents excision of a subcutaneous soft tissue tumor of the shoulder, 23075 is correct. Switching to 11402 based on a pathology result is incorrect — 11402 is for skin lesions, not deep subcutaneous tumors.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the intraoperative tumor-plus-margin measurement, anatomic depth (subcutaneous vs. subfascial), shoulder laterality, and pathology submission from dictation — the exact data points auditors check first. That prevents the most common downcode scenario: an operative note that describes the excision but omits the size measurement, forcing a payer to default to a lower-value skin lesion code.

See how Mira captures CPT 23075 documentation