Surgical removal of a subfascial (e.g., intramuscular) soft tissue tumor of the shoulder measuring less than 5 cm in greatest dimension.

Verified May 8, 2026 · 6 sources ↓

Medicare: $523.39
Work RVU: 7.22
Global, days: 90
Region: Shoulder

Drawn from CMSMdclarityPayerpriceFindacodeAAPC

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 explicitly documented as subfascial or intramuscular — not subcutaneous
Maximum tumor diameter measured and recorded as less than 5 cm (pathology or operative measurement)
Operative note names the specific fascial or muscular layer entered and dissection plane used
Laterality (left or right shoulder) clearly stated in the operative report and on the claim
Preoperative imaging or biopsy results supporting the clinical indication for excision
Pathology specimen submitted and report retained to confirm excision and characterize the lesion
Supporting ICD-10 diagnosis code tied to a neoplasm or soft tissue mass of the shoulder region

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

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 23076 covers open excision of a deep shoulder soft tissue tumor — subfascial, meaning below the fascia, typically intramuscular — with a maximum diameter under 5 cm. The depth is what separates this from the superficial subcutaneous excision codes (23071); the surgeon must dissect through or beneath the fascial layer to reach the mass. If the tumor measures 5 cm or greater, step up to 23077.

The 90-day global period applies. That window covers the day-before visit, the operative session, and all routine post-op care through day 90. Bill an E&M in that period only if the visit is unrelated to the tumor excision — and attach modifier 24. If a significant, separately identifiable E&M is provided the same day as the procedure, use modifier 25.

Site of service matters here. The HOPD rate is substantially higher than the ASC rate (see the Site of Service comparison table). Most payers expect LT or RT to lateralize the claim. Bilateral excisions — rare but possible — report with modifier 50 on a single claim line for Part B; ASCs use two lines with LT and RT separately.

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 (7.22) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (15.67) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.22
Practice expense RVU	6.82
Malpractice RVU	1.63
Total RVU	15.67
Medicare national rate	$523.39
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	$523.39
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 23076 get rejected.

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

Missing laterality — claim submitted without LT or RT modifier causing processing rejection
Depth not documented — operative note fails to confirm the mass was subfascial, triggering downcode to 23071
Tumor size not recorded intraoperatively or in pathology report, leaving medical necessity unsupported
Unbundled E&M on the same date without modifier 25, flagged as a global-period violation
Procedure terminated before excision completed but billed without modifier 52, resulting in full-rate denial
ICD-10 diagnosis code does not map to a shoulder soft tissue neoplasm or mass, causing medical necessity denial

Frequently asked questions

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

01What distinguishes 23076 from 23071?

Depth. Code 23071 is for subcutaneous (superficial) tumors under 3 cm. Code 23076 is for subfascial — below the fascia, typically intramuscular — tumors under 5 cm. The size thresholds also differ, so check both depth and diameter before selecting the code.

02When do I use 23077 instead of 23076?

Use 23077 when the subfascial shoulder tumor measures 5 cm or greater in its greatest dimension. The depth criterion (subfascial) is the same; only the size threshold separates them.

03Do I need to append LT or RT every time?

Yes. Most payers — including Medicare — require laterality for unilateral shoulder procedures. Submitting 23076 without LT or RT is a common processing rejection. Document laterality in the operative report and match it on the claim.

04Can I bill an E&M on the same day as 23076?

Only if it is significant and separately identifiable from the decision to operate — attach modifier 25. The decision to perform the procedure itself is bundled into the surgical payment and cannot be billed separately as an E&M, even for a new patient.

05What happens if no mass is found intraoperatively after exploration begins?

If dissection was initiated but the procedure was discontinued before excision, bill 23076 with modifier 52 (reduced services). Do not bill as if the full excision was completed. Document the intraoperative finding explicitly in the operative note.

06Is 23076 subject to the 90-day global period?

Yes. The 90-day global includes the day-before visit, the procedure, and all routine post-op care through day 90. An unrelated E&M visit during that window requires modifier 24; an unrelated procedure requires modifier 79.

07How does site of service affect reimbursement for 23076?

The HOPD rate is significantly higher than the ASC rate — see the Site of Service comparison table on this page. If the procedure is performed in an ASC, the facility bills separately at the lower ASC rate; the surgeon's professional fee is the same regardless of site.

Sources & references

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

Mira Scribe

For 23076, Mira's AI scribe captures tumor depth (subfascial/intramuscular), the measured diameter confirmed under 5 cm, the specific muscular layer dissected, and laterality — all from the surgeon's dictation. It also flags if the operative note only says 'deep mass' without naming the fascial plane, which is the documentation gap that drives downcoding to 23071 on audit.

See how Mira captures CPT 23076 documentation