Open partial removal or reshaping of the acromion, with or without release of the coracoacromial ligament, to relieve subacromial impingement.

Verified May 8, 2026 · 5 sources ↓

Medicare: $590.86
Total RVUs: 17.69
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCHealthcareinspiredllcFaculty

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify the surgical approach by name — do not use 'standard approach'; document open vs. mini-open vs. arthroscopic (arthroscopic approach = 29826, not 23130)
Document the extent of acromion resection: how much bone was removed and from which surface
Explicitly state whether the coracoacromial ligament was released, even though its release is included in the code
Record the pre-operative diagnosis supporting medical necessity — shoulder impingement syndrome, rotator cuff pathology, or post-traumatic changes with ICD-10 specificity and laterality
Document conservative treatment failure prior to surgery (physical therapy, injections, duration) to support medical necessity
If billing a same-day E/M with modifier 57, document that the clinical decision for surgery was made at that encounter

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 57 Decision for surgery 58 Staged or related 59 Distinct service 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 5 cited references ↓

CPT 23130 covers an open partial acromioplasty or acromionectomy — trimming or reshaping the undersurface of the acromion to decompress the subacromial space, with optional release of the coracoacromial ligament. This is the open counterpart to arthroscopic acromioplasty (29826). When the procedure is performed arthroscopically, 29826 is the correct code; 23130 is reserved for open or mini-open approaches. The coracoacromial ligament release, when performed, is included and not separately billable.

The code carries a 90-day global period. All routine post-op care, dressing changes, and shoulder rehabilitation management within that window are bundled. Separate E/M visits during the global require modifier 24 (unrelated condition) or modifier 25 (significant, separately identifiable service on the same day as a minor procedure — not applicable here given the 90-day global). When a same-day decision for surgery E/M drives the operative plan, append modifier 57 to the E/M code. Laterality modifiers LT or RT are required by most payers; missing them is a top denial trigger.

When 23130 is performed in conjunction with rotator cuff repair (e.g., 23412 open or 29827 arthroscopic), billing practices vary. For the open approach combining acromioplasty with open cuff repair, some payers bundle 23130 into the repair code; verify NCCI edits and payer policy before billing both. Modifier 51 applies when 23130 is a secondary procedure in a multi-procedure session.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.58
Practice expense RVU	8.52
Malpractice RVU	1.59
Total RVU	17.69
Medicare national rate	$590.86
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	$590.86
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 23130 get rejected.

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

Missing laterality modifier — most Medicare contractors and commercial payers require LT or RT; claims without them are returned or denied
Arthroscopic approach documented in the operative note but 23130 (open code) billed instead of 29826
Lack of documented conservative treatment failure before surgery, triggering medical necessity denial
23130 billed separately when payer bundles it into a same-session rotator cuff repair code — check NCCI edits before billing both
Post-op E/M billed without modifier 24 during the 90-day global period, resulting in automatic bundling denial

Frequently asked questions

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

01What's the difference between CPT 23130 and CPT 29826?

23130 is the open or mini-open partial acromioplasty. 29826 is the arthroscopic equivalent. The approach documented in the operative note determines which code is correct — billing 23130 when the note describes arthroscopic technique is an audit risk.

02Can I bill 23130 separately when it's performed with an open rotator cuff repair?

It depends on payer policy. NCCI edits and some commercial payers bundle acromioplasty into the cuff repair when performed through the same incision. Check NCCI PTP edits before billing both; if an edit exists and the procedures are distinct, modifier 59 or XS may apply — but confirm clinical documentation supports separate, distinct work.

03Do I need a laterality modifier on every 23130 claim?

Yes. Medicare and most commercial payers require LT or RT. Claims submitted without a laterality modifier are routinely rejected or denied. Apply RT or LT on every line, every time.

04How does modifier 57 apply to 23130?

If the surgeon performs an E/M on the same day they decide to schedule the open acromioplasty, append modifier 57 to the E/M code. 23130 has a 90-day global, making it a major procedure — modifier 57 is required on the E/M to prevent automatic bundling denial.

05Is the coracoacromial ligament release separately billable when performed with 23130?

No. The code descriptor explicitly includes coracoacromial ligament release. It is bundled regardless of whether it is performed. Do not attempt to bill a separate ligament release code for this component.

06What happens if I need to return to the OR during the 90-day global for a shoulder-related complication?

An unplanned return to the OR for a complication related to the original acromioplasty uses modifier 78. An unplanned return for a separate, unrelated shoulder or other procedure uses modifier 79. Do not invert these — incorrect modifier assignment is an audit trigger.

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 surgical approach (open vs. arthroscopic), the extent of acromion resection, coracoacromial ligament release status, and the laterality of the procedure directly from dictation. This prevents the most common audit flag on 23130 — operative notes that describe an arthroscopic technique billed under the open code, and claims submitted without laterality modifiers.

See how Mira captures CPT 23130 documentation