Surgical removal of a foreign body located in the subfascial or intramuscular tissue of the shoulder — the deep variant requiring dissection through or beneath the fascial layer.

Verified May 8, 2026 · 6 sources ↓

Medicare: $459.60
Work RVU: 5.85
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCAbosMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative note must specify the fascial or muscular plane where the foreign body was located — 'subfascial' or 'intramuscular' language required to support deep-level coding over 23330
Nature and type of foreign body identified (e.g., metallic fragment, retained suture material, organic matter) and how it was confirmed (imaging, intraoperative fluoroscopy, direct visualization)
Description of the dissection approach taken to reach the foreign body, including layers traversed and technique used for extraction
Pre-operative imaging (X-ray, CT, or MRI) documenting the depth and location of the foreign body in the shoulder soft tissues
Confirmation that the foreign body was fully retrieved, with documentation of wound closure technique and any drain placement

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 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 23333 covers open surgical extraction of a foreign body embedded in the deep soft tissues of the shoulder — specifically subfascial or intramuscular planes. This distinguishes it from 23330, which addresses subcutaneous foreign bodies requiring only superficial dissection. The depth of the object dictates the code: if the surgeon must traverse the fascia to reach the foreign material, 23333 applies.

The 90-day global period means all routine follow-up through day 90 is bundled. Any unrelated procedure performed during that window needs modifier 79. If the patient requires a return to the OR for a complication related to the original removal — irrigation, debridement of a retained fragment — that's modifier 78, not 79.

Critical NCCI rule: 23333 cannot be billed separately when the same operative session includes shoulder arthroplasty (23470 or 23472). CMS treats foreign body removal as bundled into the arthroplasty when it involves a failed prosthesis removal and joint replacement. Billing 23333 alongside those codes will generate a hard NCCI edit denial. For contralateral shoulder procedures on the same day, modifier 59 or XS may be applicable to bypass a PTP edit — but ipsilateral same-session shoulder procedure bundles generally cannot be unbundled.

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 (5.85) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (13.76) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.85
Practice expense RVU	6.66
Malpractice RVU	1.25
Total RVU	13.76
Medicare national rate	$459.60
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	$459.60
HOPD (APC 5073) Hospital outpatient department	$2,967.63
ASC (PI G2) Ambulatory surgical center (freestanding)	$1,248.36

Common denial reasons

The recurring reasons claims for CPT 23333 get rejected.

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

NCCI bundling denial when 23333 is billed alongside shoulder arthroplasty codes 23470 or 23472 on the same operative session — this edit cannot be bypassed with a modifier
Depth insufficiently documented: note says 'deep' without specifying subfascial or intramuscular plane, causing downcode to 23330
Missing pre-operative imaging or intraoperative localization documentation to justify medical necessity of surgical rather than nonsurgical removal
Incorrect laterality — no LT or RT modifier appended, triggering payer edit requiring resubmission
Ipsilateral same-session shoulder procedure pair billed without recognizing the NCCI PTP edit, and modifier applied incorrectly in an attempt to bypass a non-bypassable edit

Frequently asked questions

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

01What separates 23333 from 23330?

Depth of the foreign body. 23330 is subcutaneous — above the fascia. 23333 requires dissection through or beneath the fascia into subfascial or intramuscular tissue. The operative note must name the plane; 'deep' alone is not sufficient documentation.

02Can 23333 be billed with shoulder arthroplasty on the same day?

No. CMS NCCI policy explicitly prohibits billing 23333 separately with 23470 or 23472. When arthroplasty includes removal of a failed prosthesis, foreign body removal is bundled. There is no modifier that overrides this edit.

03What modifier applies if the patient returns to the OR during the 90-day global for a related complication?

Modifier 78 — unplanned return to the OR for a complication related to the original procedure. Do not use 79 for related complications; 79 is reserved for unrelated procedures performed during the postoperative period.

04Is fluoroscopy separately billable when used to locate the foreign body intraoperatively?

Payer-variable. Some payers bundle intraoperative fluoroscopy guidance into the surgical code; others allow separate reporting with the appropriate imaging guidance code. Verify payer policy and document the use of fluoroscopy explicitly in the operative note.

05If the surgeon performs 23333 on both shoulders in the same session, how is it billed?

Bill 23333 twice — once with modifier LT and once with modifier RT. Modifier 50 (bilateral) is an alternative some payers prefer; confirm payer-specific preference. Ipsilateral same-session NCCI edits do not apply to contralateral procedures.

06Does the 90-day global period cover imaging ordered to confirm full foreign body retrieval after surgery?

Post-op imaging is generally bundled into the global period if it is a routine part of follow-up care. If imaging is ordered for a new problem or a separate clinical concern unrelated to the foreign body removal, bill with modifier 24 and supporting documentation.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the tissue plane (subfascial vs. intramuscular), the method of foreign body localization (fluoroscopy, direct visualization, palpation), the nature and description of the retrieved object, and the layers of dissection documented in dictation. This prevents the most common audit flag on 23333: operative notes that state 'deep removal' without naming the anatomic plane, which reviewers use to downcode to the subcutaneous code 23330.

See how Mira captures CPT 23333 documentation