Single muscle transfer to the shoulder or upper arm, moving a muscle from its origin to restore lost function in the affected region.

Verified May 8, 2026 · 8 sources ↓

Medicare: $1,177.72
Total RVUs: 35.26
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCMdclarityKzanowFindacode

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Operative note must name the specific muscle transferred (e.g., pectoralis major, trapezius, latissimus dorsi) and the recipient site
Document the clinical indication that necessitates transfer rather than repair — nerve injury, irreparable muscle loss, paralysis, or prior failed repair
Preoperative workup should reference EMG, nerve conduction studies, or MRI findings that confirm functional deficit and guide surgical planning
Clearly distinguish transfer (new anatomical location) from reattachment or repair (original insertion) — conflating these terms is the most common audit flag
If billed with additional shoulder codes, operative note must delineate separate dissection planes, distinct operative steps, and independent indications for each reported procedure
Laterality (left vs. right shoulder/arm) must be explicitly stated in both the note and on the claim

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 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 8 cited references ↓

CPT 23395 covers a single muscle transfer procedure at the shoulder or upper arm — surgically detaching a muscle from its native origin and reattaching it at a new site to compensate for lost motor function. Typical indications include scapular winging (pectoralis major transfer to address serratus anterior palsy), axillary nerve palsy, brachial plexus injury sequelae, or post-traumatic muscle loss that cannot be addressed by repair alone. The distinction between 'transfer' and 'repair' or 'reattachment' is clinically and codologically significant: moving a muscle to a new anatomical location is a transfer; reattaching a detached muscle back to its original insertion is not.

The 90-day global period bundles all related post-op visits, wound checks, and routine follow-up. Separate E/M services within that window require modifier 24. When a second, distinct muscle is transferred in the same shoulder during the same session, 23397 (multiple transfers) applies instead of billing 23395 twice. Laterality modifiers LT and RT are expected on all unilateral shoulder procedures — missing them is a fast path to a technical denial.

Bundling scrutiny is real here: payers and NCCI edits will challenge 23395 billed alongside rotator cuff or biceps tendon codes unless the operative note clearly documents that the muscle transfer was a separate, distinct procedure with its own indication, dissection planes, and fixation. Modifier 59 or XS supports unbundling when clinically justified, but the operative note has to carry the argument.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	18.08
Practice expense RVU	13.46
Malpractice RVU	3.72
Total RVU	35.26
Medicare national rate	$1,177.72
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	$1,177.72
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 23395 get rejected.

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

Laterality modifier LT or RT missing from the claim line — automatic technical denial by most payers
Operative note describes reattachment or repair to original insertion rather than true anatomical transfer to a new site, triggering medical necessity denial
23395 billed alongside biceps tendon or rotator cuff codes without modifier 59/XS and supporting documentation that the transfer was a separately identifiable procedure
23397 should have been billed when two or more muscles were transferred in the same shoulder during the same session — billing 23395 twice for the same shoulder is incorrect and will be denied or downcoded
Insufficient preoperative documentation (no EMG, no imaging, no prior conservative treatment record) to support medical necessity for muscle transfer over less invasive options

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01When should I use 23397 instead of 23395?

Use 23397 when two or more muscles are transferred at the shoulder or upper arm in the same operative session. Do not bill 23395 twice for the same shoulder — that will be denied. 23397 is the correct single-code solution for multiple transfers.

02Does reattaching the pectoralis major to the chest wall after breast implant placement bill as 23395?

No. Putting a muscle back to its original insertion is not a transfer. Per KZA coding guidance, that service is bundled into the primary breast reconstruction procedure. Append modifier 22 to the primary code if the work was significantly more extensive than usual — do not separately report 23395.

03Can I bill 23395 with arthroscopic rotator cuff repair codes on the same day?

Yes, but only if the muscle transfer was a truly distinct procedure with a separate indication, separate dissection, and separate fixation. Document each step independently in the operative note and append modifier 59 or XS. Payers will scrutinize this combination — the note has to make the case, not just the modifier.

04Is modifier 50 appropriate for bilateral muscle transfers?

Bilateral shoulder muscle transfers in a single session are rare but possible. If performed bilaterally, append modifier 50 and verify the specific payer's bilateral payment policy — some require LT and RT on separate lines instead of modifier 50 on a single line.

05What global period applies to 23395 and what does that mean for post-op billing?

The global period is 90 days. All routine post-op visits, wound checks, and stitch removals within that window are bundled — bill them separately only if they address an unrelated condition (modifier 24) or a new problem requiring a significant, separately identifiable E/M (modifier 25 applies pre-op on the day of surgery if a separate E/M drove the decision to operate).

06Does 23395 require prior authorization, and what documentation should accompany the PA request?

Most commercial payers require prior authorization for this procedure. Submit EMG or nerve conduction study results, MRI or imaging reports documenting muscle/nerve pathology, documentation of failed conservative management, and the surgeon's operative plan specifying which muscle will be transferred and why.

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 transferred muscle by name, the donor and recipient sites, the fixation method, and the clinical indication (e.g., scapular winging from serratus anterior palsy, axillary nerve injury, brachial plexus deficit) directly from surgeon dictation. It flags when dictation uses 'reattachment' or 'repair' language instead of true transfer language — the distinction that most commonly triggers a payer's medical necessity denial or a request to recode to a lower-value repair code.

See how Mira captures CPT 23395 documentation