Open incision into the glenohumeral joint for tissue biopsy

Verified May 8, 2026 · 5 sources ↓

Medicare: $491.33
Work RVU: 6.05
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCFastrvuAAOS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Explicit identification of the glenohumeral joint as the operative site — not just 'shoulder joint'
Description of the arthrotomy approach, including capsulotomy technique
Confirmation that tissue biopsy was obtained and submitted to pathology
Laterality documented (right vs. left shoulder)
Clinical indication justifying open joint biopsy over less invasive diagnostic alternatives
Pathology requisition or specimen label corroborating the biopsy

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 52 Reduced services 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 5 cited references ↓

CPT 23100 covers an open arthrotomy of the glenohumeral joint performed specifically to obtain a tissue biopsy. The surgeon incises down to the glenohumeral joint, opens the joint capsule, and excises tissue for pathologic analysis. The biopsy is integral to the procedure — you cannot report it separately with an additional biopsy code.

Joint specificity drives code selection here. 23100 is glenohumeral only. If the surgeon opened the acromioclavicular or sternoclavicular joint instead, 23101 applies. If the glenohumeral arthrotomy included synovectomy, step up to 23105. Always verify joint identity in the operative note before finalizing the code.

The 90-day global period means all routine post-op shoulder care through day 90 is bundled. Any unrelated procedure or E/M in that window requires modifier 79 or 24, respectively. Laterality modifiers (LT or RT) are required — claims without them will reject at most payers.

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 (6.05) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (14.71) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.05
Practice expense RVU	7.37
Malpractice RVU	1.29
Total RVU	14.71
Medicare national rate	$491.33
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	$491.33
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 23100 get rejected.

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

Missing laterality modifier — most payers require LT or RT on all shoulder codes
Separately billed biopsy code alongside 23100 — biopsy is integral and not separately reportable
Wrong joint identified — billing 23100 when the operative note documents acromioclavicular or sternoclavicular access
Lack of medical necessity documentation — payers require clinical rationale for open over arthroscopic or needle biopsy approaches
Post-op services billed without modifier 24 or 79 during the 90-day global period

Frequently asked questions

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

01Can I bill a separate biopsy code in addition to 23100?

No. The biopsy is included in 23100's descriptor. Reporting a standalone biopsy code alongside it will trigger a bundling denial.

02Which code applies if the surgeon opened the AC joint instead of the glenohumeral joint?

Use 23101, which covers arthrotomy of the acromioclavicular or sternoclavicular joint with biopsy. 23100 is glenohumeral only — using it for AC joint work is an incorrect code assignment.

03Is a laterality modifier required on 23100?

Yes. Append RT or LT on every claim. Most payers reject shoulder procedure codes submitted without a laterality modifier, and Medicare follows the same convention.

04What's the global period for 23100 and what does it cover?

23100 carries a 90-day global. That bundles the day-before pre-op visit, the procedure, and all routine post-op shoulder follow-up through day 90. Unrelated procedures in that window need modifier 79; unrelated E/M visits need modifier 24.

05If the glenohumeral arthrotomy also included a synovectomy, is 23100 still correct?

No. When the arthrotomy includes synovectomy, report 23105 instead. 23100 is appropriate only when the procedure is limited to joint access and biopsy without synovectomy.

06When is modifier 22 appropriate on 23100?

Use modifier 22 when documented circumstances — severe adhesive capsulitis, prior surgery with dense scarring, or unusual anatomy — required substantially more work than the typical arthrotomy with biopsy. The operative note must describe the added complexity; modifier 22 without supporting documentation will be disregarded or denied.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the joint name (glenohumeral), surgical approach, capsulotomy technique, and confirmation that tissue was excised and submitted to pathology — directly from dictation. It also flags laterality so the coder receives a note that already includes RT or LT. That prevents the two most common 23100 denials: wrong joint coded and missing laterality modifier.

See how Mira captures CPT 23100 documentation