Open arthrotomy of the sternoclavicular joint with synovectomy, with or without biopsy — used to treat inflammatory joint disease at the SC joint through direct surgical access.

Verified May 8, 2026 · 7 sources ↓

Medicare: $487.99
Total RVUs: 14.61
Global, days: 90
Region: Shoulder

Drawn from CMSAbosAAPCFindacodeCovenanthealthcare

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify the joint by name: sternoclavicular joint, not 'shoulder joint' or 'clavicular joint'
Document the indication — inflammatory arthritis, septic arthritis, or other synovial pathology — with supporting imaging or prior failed conservative treatment
Operative note must name the surgical approach and confirm synovectomy was performed, not just exploration or drainage
If biopsy was obtained, document that tissue was sent for pathology and include specimen laterality (right or left SC joint)
Record pre-op exam findings, range of motion, and pain localized to the SC joint to support medical necessity
Note any prior injections or non-operative management attempted before open surgery

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 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 23106 covers open surgical entry into the sternoclavicular (SC) joint with removal of the synovial lining, performed to address inflammatory conditions such as rheumatoid arthritis or septic arthritis that have not responded to conservative care. The surgeon opens the joint directly, excises pathologic synovium, and may harvest tissue for biopsy. Unlike the neighboring acromioclavicular joint procedures, 23106 is SC-joint specific — don't confuse it with 23101 (arthrotomy with biopsy/cartilage excision, AC or SC) or 23044 (exploration/drainage, AC or SC). The distinctions matter because payers audit code selection against operative note anatomy.

The 90-day global period means all routine post-op care through day 90 is bundled. Any E/M visit in that window for a new or unrelated problem needs modifier 24; a significant, separately identifiable E/M on the day of surgery needs modifier 25. Several payers — including BCBS managed-care plans administered through TurningPoint — require prior authorization for 23106. Verify auth before scheduling; missing auth is a clean-claim killer on a procedure with this global exposure.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.98
Practice expense RVU	7.35
Malpractice RVU	1.28
Total RVU	14.61
Medicare national rate	$487.99
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	$487.99
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 23106 get rejected.

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

Missing prior authorization — multiple payers including TurningPoint-managed plans require pre-auth for 23106
Operative note documents exploration or drainage only, which maps to 23044, not 23106
Insufficient documentation of medical necessity: no imaging, no prior conservative treatment noted
Laterality missing — claim submitted without LT or RT modifier causing edit-based rejection
Billing a same-day E/M without modifier 25, triggering bundling into the surgical payment
Wrong code selected — 23101 used when synovectomy (not just biopsy/cartilage excision) was performed

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What separates 23106 from 23101 and 23044?

23044 is exploration, drainage, or foreign body removal at the AC or SC joint — no synovectomy. 23101 covers arthrotomy with biopsy and/or torn cartilage excision at the AC or SC joint, but not synovectomy. 23106 is SC-joint-specific and requires synovectomy. If the operative note documents synovectomy at the SC joint, 23106 is the right code.

02Do I need to append a laterality modifier?

Yes. Append LT or RT on every claim. The SC joint is a paired structure and Medicare contractors expect laterality. Missing it generates an edit that stalls payment or triggers rejection.

03Is prior authorization required for 23106?

Payer-variable, but the answer is often yes. BCBS managed-care products using TurningPoint Healthcare Solutions explicitly list 23106 as requiring authorization. Verify with each commercial and Medicare Advantage plan before scheduling the case.

04What does the 90-day global period cover?

The global covers the day-before visit, the surgery itself, and all routine post-op care through day 90 — office visits, dressings, and stitch removal. Unrelated E/M visits in that window need modifier 24. A co-surgeon or assistant surgeon bills the same code with modifier 62 or 80 respectively.

05Can 23106 be billed bilaterally?

Bilateral SC joint synovectomy at the same session is rare but codeable. Append modifier 50 and bill on one line. Reimbursement is capped at 150% of the single-procedure allowable under Medicare rules. Document separate findings and medical necessity for each side in the operative note.

06What ICD-10 diagnoses support 23106 medically?

Rheumatoid arthritis with SC joint involvement, septic arthritis of the SC joint, and synovitis/tenosynovitis localized to the SC joint are the most defensible primary diagnoses. The diagnosis code must be specific to the sternoclavicular joint — unspecified shoulder or shoulder region codes invite scrutiny.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the joint name (sternoclavicular, not glenohumeral or AC), the specific procedure performed (synovectomy with or without biopsy), the surgical approach, and the laterality directly from dictation. It also flags whether a biopsy specimen was submitted to pathology. This prevents the most common audit trigger on 23106: an operative note that describes exploration or drainage — pointing to 23044 — instead of synovectomy, which is the distinguishing work element for this code.

See how Mira captures CPT 23106 documentation