Open arthrotomy of the glenohumeral joint for exploration, with or without removal of loose or foreign bodies.

Verified May 8, 2026 · 6 sources ↓

Medicare: $626.27
Work RVU: 8.65
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCHealthcareinspiredllcAbosAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Indication for open exploration — why arthroscopic approach was not used or was insufficient
Intra-operative findings described in specific anatomical terms (e.g., loose cartilage fragment at posterior glenoid, foreign body in the inferior recess)
Description of material removed: size, quantity, character of loose bodies or foreign material
Surgical approach documented by name (e.g., deltopectoral, anterior capsulotomy) — notes that say 'standard approach' are audit flags
Confirmation that synovectomy was NOT performed, to distinguish from 23105
Pre-op imaging or clinical findings supporting medical necessity for open rather than arthroscopic exploration

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 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 LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 23107 covers an open surgical approach to the glenohumeral joint — the surgeon incises down to the joint, inspects the intra-articular structures, and removes loose bodies, cartilage fragments, or foreign material as found. This is a distinctly open procedure; the arthroscopic equivalent for loose body removal is 29819. If the open approach also includes synovectomy, bill 23105 instead — that code bundles the synovectomy work that 23107 does not cover.

The 90-day global period means all routine post-op office visits, dressing changes, and wound checks through day 90 are bundled into the surgical payment. Any E/M for an unrelated condition during that window requires modifier 24. A separate significant and identifiable E/M on the day of surgery requires modifier 25. If a related complication requires a return to the OR within the global, use modifier 78; an unrelated return-to-OR procedure uses modifier 79.

Site of service matters here: HOPD and ASC payments differ substantially — see the Site of Service comparison table. Most payers expect the operative note to clearly document the indication, the findings on exploration, and exactly what was removed. Notes that describe findings generically without specifying loose body characteristics, location, or foreign body type draw audit scrutiny.

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 (8.65) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (18.75) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.65
Practice expense RVU	8.3
Malpractice RVU	1.8
Total RVU	18.75
Medicare national rate	$626.27
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	$626.27
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 23107 get rejected.

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

Operative note too vague — fails to describe specific findings or material removed, making medical necessity unsupported
Bundling conflict when 29819 (arthroscopic loose body removal) is billed same-session without a modifier and clear documentation of two distinct approaches
Upcoding flag if 23107 is billed but the note documents synovectomy, which belongs under 23105
Missing modifier 59 or XS when billed alongside another shoulder procedure that has an NCCI column-one/column-two relationship with 23107
Global period violation — post-op E/M billed without modifier 24 when the visit is unrelated to a different diagnosis

Frequently asked questions

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

01What's the difference between 23107 and 29819?

23107 is the open arthrotomy for exploration and loose body removal. 29819 is the arthroscopic equivalent. They describe the same clinical goal via different surgical approaches. Bill the one that matches what was actually performed — don't bill both for the same shoulder on the same day unless there's clear documentation of a distinct open and arthroscopic phase, which is exceedingly rare.

02When should I use 23105 instead of 23107?

If the open exploration also included a synovectomy (partial or complete), 23105 is the correct code — it specifically bundles glenohumeral arthrotomy with synovectomy. Use 23107 only when no synovectomy was performed.

03Can I bill an E/M on the same day as 23107?

Only if it's a significant and separately identifiable service unrelated to the decision to perform the surgery. Append modifier 25 to the E/M. The decision-for-surgery visit the day before or day of carries modifier 57 since 23107 has a 90-day global.

04Does 23107 carry a bilateral modifier, and how do I report it?

Bilateral glenohumeral open exploration is anatomically possible but clinically unusual. If billed bilaterally for a physician claim, report with modifier 50 on a single line. ASCs report on two lines using LT and RT per NCCI bilateral reporting rules.

05What ICD-10 diagnoses are most commonly paired with 23107?

Common pairings include M25.311 (pain in right shoulder) or M25.312 (left), M24.011–M24.012 (loose body in shoulder), and T14.8XXA-series for foreign body. The diagnosis must justify open exploration — a loose body or foreign body finding on imaging is the clearest support for medical necessity.

06If the surgeon finds more pathology than expected during exploration and adds significant extra work, can modifier 22 be used?

Yes. If the exploration reveals substantially more complexity — for example, multiple large osteochondral fragments requiring significant operative time beyond typical — modifier 22 is appropriate. You must attach a letter to the claim explaining the added complexity, and the operative note must support it. Payer acceptance varies; some commercial payers require pre-authorization review.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the surgical approach by name, the specific intra-articular findings on exploration, the anatomical location of each loose body or foreign material encountered, a description of what was removed, and the surgeon's rationale for open versus arthroscopic access. That specificity prevents the most common denial for 23107: a vague operative note that can't support medical necessity on audit.

See how Mira captures CPT 23107 documentation