Removal of a total shoulder prosthesis, covering both the humeral and glenoid components, including any debridement and synovectomy performed at the same time.

Verified May 8, 2026 · 5 sources ↓

Medicare: $1,148.32
Total RVUs: 34.38
Global, days: 90
Region: Shoulder

Drawn from CMSAAPC

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Confirm both humeral and glenoid components were removed — if only one component is removed, 23334 applies instead of 23335.
Document the indication for explantation (e.g., periprosthetic infection with organism and culture data, aseptic loosening, implant failure).
Record whether debridement and/or synovectomy were performed — these are included in 23335 and must not be billed separately.
If antibiotic spacer was placed, document spacer type and confirm this is a staged explantation, supporting modifier 58 for future reimplantation.
Note laterality explicitly (left or right shoulder) to support LT or RT modifier.
For revision cases, document that this was explantation-only with no same-session prosthetic replacement — required to rebut NCCI bundling edits.

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 62 Co-surgeons 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 23335 covers explantation of both the humeral and glenoid components of a shoulder arthroplasty, with debridement and synovectomy included when performed — meaning those are never separately billable in the same operative session. This is the highest-complexity code in the shoulder prosthesis removal family: 23334 covers a single component (humeral or glenoid), while 23335 applies when both are removed. Common indications include periprosthetic joint infection requiring explantation with or without antibiotic spacer placement, aseptic loosening of both components, and implant failure requiring staged revision.

A critical NCCI rule governs revision arthroplasty scenarios: when the surgeon removes a failed total shoulder and immediately implants a new prosthesis (23470 or 23472), 23335 cannot be billed separately. The removal is bundled into the replacement arthroplasty code. Bill 23335 only when the case is explantation-only — no same-session replacement. For staged revision where removal and reimplantation are separate operative episodes, modifier 58 supports the second-stage claim.

The 90-day global period means all routine post-op care through day 90 is included in the surgical payment. Complications requiring an unplanned return to the OR for a related procedure during that window bill with modifier 78. An unrelated procedure in the same global window uses modifier 79. For infected cases, document the infecting organism, culture results, antibiotic spacer placement if performed, and the staged-revision plan — audit teams look for this to justify the complexity of the encounter.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	18.53
Practice expense RVU	12.1
Malpractice RVU	3.75
Total RVU	34.38
Medicare national rate	$1,148.32
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	$1,148.32
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,996.77

Common denial reasons

The recurring reasons claims for CPT 23335 get rejected.

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

NCCI bundling denial when 23335 is billed same-day with 23470 or 23472 — removal is included in the replacement arthroplasty and cannot be reported separately.
Upcoding flag when only one component is removed and 23335 is submitted instead of 23334 — operative note must name both humeral and glenoid component extraction.
Missing modifier 58 on the reimplantation claim when staged revision occurs within the 90-day global period of the initial 23335 explantation.
Insufficient documentation of medical necessity — payers require explicit indication (infection with organism, aseptic loosening with imaging correlation) to approve a high-RVU removal-only case.
Laterality modifier absent — some payers require LT or RT on all unilateral shoulder procedures; missing modifier triggers automatic edits.

Frequently asked questions

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

01What is the difference between 23334 and 23335?

23334 covers removal of a single shoulder prosthetic component — humeral or glenoid. 23335 applies only when both the humeral and glenoid components are removed in the same surgical session. If your operative note doesn't document extraction of both components, use 23334.

02Can I bill 23335 with 23472 when I remove the failed total shoulder and place a new one the same day?

No. NCCI policy explicitly bundles 23335 into 23472 (and 23470) when removal and replacement occur in the same operative session. Bill only the replacement arthroplasty code. 23335 is payable only when explantation is the final procedure for that operative encounter — no same-day reimplantation.

03How do I bill the second stage of a staged revision when I previously billed 23335 for explantation?

The reimplantation (23472 or 23470) falls within the 90-day global of 23335. Append modifier 58 to the reimplantation code to indicate it is a planned staged procedure. Without modifier 58, the claim will deny as a global period service.

04Does 23335 include debridement and synovectomy, or do I bill those separately?

Both are included in 23335 and cannot be billed separately in the same session. Billing 23335 plus a debridement or synovectomy code for the same shoulder on the same date will trigger an NCCI bundling denial.

05When is modifier 22 appropriate with 23335?

Use modifier 22 when the removal required substantially more work than typical — severe periprosthetic infection with extensive bone loss, dense fibrous encapsulation, or grossly failed cement requiring prolonged extraction. The operative note must quantify the extra time and difficulty. Without that documentation, payers will disregard the modifier.

06What global period applies to 23335, and what does that mean for post-op billing?

23335 carries a 90-day global period. Routine post-op visits, dressing changes, and stitch removal through day 90 are included in the surgical payment. For unrelated E&M services in that window, append modifier 24. For an unplanned return to the OR for a related complication, use modifier 78.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures whether one or both prosthetic components were removed, the stated indication (infection with culture data, aseptic loosening, mechanical failure), whether debridement or synovectomy was performed, antibiotic spacer placement, and the planned staging approach. That documentation prevents the most common denial: a payer challenging 23335 because the note doesn't confirm both humeral and glenoid components were extracted, or bundling the removal with a same-session replacement arthroplasty.

See how Mira captures CPT 23335 documentation