Injection of contrast agent into the glenohumeral joint to enable shoulder arthrography imaging — covers needle placement, contrast administration, and fluoroscopic confirmation of intra-articular position.

Verified May 8, 2026 · 7 sources ↓

Medicare: $156.98
Total RVUs: 4.7
Global, days: 0
Region: Shoulder

Drawn from CMSBedrockbillingPabauMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Identity and concentration of contrast agent used (e.g., Omnipaque 300), with volume injected in mL
Fluoroscopic spot images or written confirmation of intra-articular needle tip position before contrast delivery
Clinical indication establishing medical necessity — plain radiographs equivocal for rotator cuff tear, labral pathology, or adhesive capsulitis
Identification of the follow-on imaging modality performed: radiographic arthrogram (73040), CT arthrogram (73201), or MR arthrogram (73222)
Any resistance encountered during injection, which may indicate adhesive capsulitis and supports the clinical picture
Provider performing the injection identified separately from the interpreting radiologist if split-billing applies

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

26 Professional component 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 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 7 cited references ↓

CPT 23350 covers the contrast injection procedure performed before shoulder arthrography — whether the follow-on imaging is conventional radiographic arthrogram (73040), CT arthrogram (73201), or MR arthrogram (73222). The code covers the entire injection encounter: needle placement under fluoroscopic guidance, contrast delivery, and spot-image confirmation that the agent is seated within the joint space. The downstream imaging study is billed separately with its own code.

This is a procedure-only code with a 000 global period, meaning no pre- or post-operative visits are bundled. It is billed by the injecting clinician — typically an orthopedic surgeon or radiologist performing the joint injection. When one provider injects and a separate radiologist interprets the imaging study, split-billing applies: the injecting physician bills 23350 (no modifier), and the interpreting radiologist bills the imaging code with modifier 26. Facilities providing equipment and space without professional services bill the imaging code with modifier TC.

The most common clinical indications are suspected rotator cuff tears, labral pathology, or adhesive capsulitis where plain radiographs are inconclusive. Fluoroscopic guidance confirming intra-articular needle position is a documentation requirement — notes that describe contrast injection without confirming joint entry invite medical necessity scrutiny. Always link 23350 to the corresponding imaging code in the claim to prevent bundling confusion.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	0.98
Practice expense RVU	3.63
Malpractice RVU	0.09
Total RVU	4.7
Medicare national rate	$156.98
Global period	0 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	$156.98

Common denial reasons

The recurring reasons claims for CPT 23350 get rejected.

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

Missing or inadequate documentation of intra-articular needle placement under fluoroscopic guidance
Failure to link 23350 to the corresponding imaging code (73040, 73201, or 73222), triggering bundling or medical necessity edits
Billing 23350 and the imaging code by the same provider without understanding split-component billing rules, resulting in duplicate-service denials
Absent or insufficient clinical justification — no documentation that plain films were inconclusive prior to ordering arthrography
Incorrect modifier usage when 23350 is billed same-day with unrelated procedures during an existing global period

Frequently asked questions

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

01Do I need a separate code for fluoroscopic guidance when billing 23350?

No. Fluoroscopic guidance for shoulder joint injection is considered integral to 23350 and is not separately billable. Billing 77002 alongside 23350 will be bundled under NCCI edits.

02How do I bill when my surgeon does the injection and a radiologist reads the images?

The injecting surgeon bills 23350 without a modifier. The radiologist bills the imaging code (73040, 73201, or 73222) with modifier 26 for professional interpretation only. The facility bills the imaging code with modifier TC for equipment and space.

03Can 23350 be billed bilaterally?

Yes, if both shoulders are injected in the same session, bill 23350 with modifier 50. Alternatively, bill 23350-LT and 23350-RT as separate line items depending on payer preference — confirm with the specific payer before submitting.

04What imaging codes pair with 23350?

Bill 73040 for radiographic shoulder arthrogram, 73201 for CT arthrogram with contrast, and 73222 for MR arthrogram with contrast. Always report the imaging code on the same claim to establish the clinical sequence and prevent bundling confusion.

05Is there a global period for 23350 that affects same-day E/M billing?

23350 carries a 000 global period — just the day of service. A same-day E/M for a separately identifiable decision (e.g., reviewing imaging findings and updating the treatment plan) can be billed with modifier 25, but the E/M must be independently documented.

06What is the NCCI edit involving 62323 and 23350?

When 62323 (epidural injection, lumbar or sacral) is billed on the same claim as 23350, NCCI bundles 23350 as the column 2 component code. A modifier is allowed to bypass this edit if the services are truly distinct and separately documented.

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 contrast agent name and volume, fluoroscopic confirmation language, needle placement approach, any resistance noted during injection, and the follow-on imaging modality ordered — all from dictation. That documentation prevents the two most common denial triggers for 23350: missing intra-articular confirmation and an absent link to the corresponding arthrography imaging code.

See how Mira captures CPT 23350 documentation