Radical resection of a soft tissue tumor smaller than 5 cm from the shoulder area, including wide excision of surrounding tissue and structures suspected of involvement.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $1,051.46
- Total RVUs
- 31.48
- 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 size documented in centimeters, confirmed as less than 5 cm
- Operative note explicitly describes radical resection technique, not simple excision
- Identification of tissue planes and structures excised beyond tumor borders
- Pathology report correlating specimen size with intraoperative measurement
- Imaging (MRI preferred) demonstrating tumor location, depth, and extent within shoulder soft tissue
- Clinical or pathological indication supporting malignant or aggressive tumor behavior (e.g., sarcoma)
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 23077 covers radical resection of a soft tissue tumor — typically a sarcoma — measuring less than 5 cm from the shoulder region. Unlike simple excision codes (23075, 23076), radical resection is not confined to the tumor margin. The surgeon removes the lesion along with a wide cuff of surrounding tissue and any anatomical structures suspected of involvement. The operative extent distinguishes this from excision codes and drives the significantly higher RVU weight.
The 90-day global period governs all routine post-operative care through day 90. Pre-op visits the day before surgery, wound checks, suture removal, and standard follow-up are included in the global payment. Separate billing within that window requires modifier 24 (unrelated E/M) or modifier 78/79 for return-to-OR scenarios. Surgical oncology and orthopedic oncology specialists bill this code most frequently.
Size thresholds and resection type are the two most audited elements for this code family. CPT 23077 sits at the intersection of both: tumor under 5 cm and radical (not simple) resection. If the specimen measurement at pathology exceeds 5 cm, the correct code is 23078. Document tumor dimensions and resection margins explicitly in the operative note — vague size descriptions and failure to justify the radical approach are the leading reasons for downcoding to 23075 or 23076.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 17.22 |
| Practice expense RVU | 10.33 |
| Malpractice RVU | 3.93 |
| Total RVU | 31.48 |
| Medicare national rate | $1,051.46 |
| 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 | $1,051.46 |
HOPD (APC 5073) Hospital outpatient department | $2,967.63 |
ASC (PI R2) Ambulatory surgical center (freestanding) | $1,248.36 |
Common denial reasons
The recurring reasons claims for CPT 23077 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Downcoded to 23075 or 23076 when operative note fails to describe radical resection beyond tumor margins
- Size mismatch between pathology report and billed code — specimen over 5 cm should be 23078
- Missing or inadequate pathology report to support malignant/aggressive diagnosis
- Post-op services billed separately without modifier 24 or 79 during the 90-day global period
- Lack of preoperative imaging documentation to establish tumor depth and shoulder-area location
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What separates CPT 23077 from 23075 and 23076?
02When does tumor size cross to CPT 23078?
03Can 23077 be billed bilaterally?
04What modifier applies if a second surgeon assists with resection?
05Are debridement codes separately billable during the same session?
06Does modifier 22 ever apply to 23077?
07What ICD-10 diagnoses support 23077?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02emedny.orghttps://www.emedny.org/providermanuals/physician/pdfs/physician%20procedure%20codes%20sect5.pdf
- 03cms.govhttps://www.cms.gov/files/document/2025nccimedicarepolicymanualcompletepdf.pdf
- 04cms.govhttps://www.cms.gov/files/document/04-chapter4-ncci-medicare-policy-manual-2025finalcleanpdf.pdf
- 05aapc.comhttps://www.aapc.com/codes/cpt-codes/23077
- 06billrazor.comhttps://billrazor.com/bundling/23077-resect-shoulder-tumor-5-cm
Mira AI Scribe
Mira's AI scribe captures tumor size in centimeters from dictation, the specific resection technique (radical vs. excision), tissue planes and structures removed beyond the tumor, and the surgeon's intraoperative margin assessment. This directly prevents downcoding to 23075 or 23076 — the most common audit outcome when operative notes describe the approach generically rather than explicitly justifying radical resection.
See how Mira captures CPT 23077 documentation