Surgical transfer of multiple muscles to the shoulder or upper arm to restore function impaired by injury, disease, or prior surgery.
Verified May 8, 2026 · 8 sources ↓
- Medicare
- $1,042.78
- Total RVUs
- 31.22
- Global, days
- 90
- Region
- Shoulder
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 8 cited references ↓
- Identify each muscle transferred by name, origin, and new insertion site — 'multiple muscles' without specifics will not support the code
- State the indication: nerve injury, irreparable rotator cuff, brachial plexus palsy, oncologic defect, or other diagnosis driving the transfers
- Confirm the procedure is performed on the shoulder or upper arm; transfers limited to the elbow region use different codes (e.g., 24301)
- Specify the number of distinct muscles transferred — this is the deciding factor separating 23397 from 23395
- Document approach, patient positioning, harvest site if donor muscle is taken from a distant location, and any graft or fixation used
- Record operative time and any unusual anatomical findings if billing modifier 22 for increased procedural services
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 8 cited references ↓
CPT 23397 covers the transfer of multiple muscles to the shoulder or upper arm in a single operative session. The surgeon moves muscle units from their native origin or insertion to a new position — either within the shoulder girdle or from a distant site — to compensate for irreparable muscle damage, nerve injury, or chronic weakness that has left the patient with significant loss of upper extremity function. Common clinical indications include brachial plexus injuries, deltoid paralysis, irreparable rotator cuff tears, and post-traumatic or post-oncologic reconstruction.
The distinction between 23397 (multiple) and its sibling code 23395 (single) turns entirely on the number of muscles transferred, not the number of tendons or the complexity of a single transfer. If only one muscle is moved — regardless of how technically demanding — 23395 applies. Two or more muscles transferred in the same shoulder or upper arm session drives the code to 23397. Both codes carry a 90-day global period, so all routine follow-up through postoperative day 90 is bundled.
With a 90-day global, any E/M visit billed in the postoperative window for an unrelated problem requires modifier 24. A separate procedure performed during the global for a related indication needs modifier 78 (unplanned return, related). An unrelated procedure in the global period requires modifier 79. Modifier 22 is defensible when operative time and intraoperative complexity are substantially above the norm — document the specific factors that drove the added work.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 16.34 |
| Practice expense RVU | 11.4 |
| Malpractice RVU | 3.48 |
| Total RVU | 31.22 |
| Medicare national rate | $1,042.78 |
| 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 | $1,042.78 |
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 23397 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Operative note names only one muscle transferred — payer downcodes to 23395 (single) with the difference recovered on appeal only if documentation is amended
- Insufficient medical necessity documentation: no imaging, nerve conduction studies, or conservative treatment history to justify surgical reconstruction
- Global period conflict: follow-up E/M billed without modifier 24 when the visit falls within the 90-day postoperative window
- Incorrect site-of-service billing: procedure performed in ASC but billed at HOPD rate, or vice versa, triggering a payment adjustment
- Bundling conflict when additional shoulder procedures billed same-day lack modifier 51 or 59/XS to establish separate service
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 8 cited references ↓
01What separates 23397 from 23395?
02Why does 23395 (single) sometimes reimburse higher than 23397 (multiple)?
03Can 23397 be billed bilaterally?
04How do I bill a same-day procedure alongside 23397?
05What modifier applies if the patient returns to the OR within the 90-day global for a complication related to the muscle transfer?
06Is prior authorization typically required for 23397?
07Can modifier 22 be used if the transfers were more technically demanding than usual?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/files/document/2025nccimedicarepolicymanualcompletepdf.pdf
- 03cms.govhttps://www.cms.gov/files/document/01-chapter1-ncci-medicare-policy-manual-2025finalcleanpdf.pdf
- 04abos.orghttps://www.abos.org/wp-content/uploads/2019/12/sports-cpt-updated.pdf
- 05faculty.washington.eduhttps://faculty.washington.edu/alexbert/Shoulder/Codes.htm
- 06vsac.nlm.nih.govhttps://vsac.nlm.nih.gov/context/cs/codesystem/CPT/version/2019/code/23397/info
- 07aapc.comhttps://www.aapc.com/codes/cpt-codes/23397
- 08emedny.orghttps://www.emedny.org/providermanuals/physician/pdfs/physician%20procedure%20codes%20sect5.pdf
Mira AI Scribe
Mira's AI scribe captures the name, origin, and new insertion of each muscle transferred directly from dictation, along with the operative indication, approach, and any distant harvest site. That specificity prevents the most common denial for 23397 — a note that documents 'multiple muscle transfers' without naming the muscles, which gives payers grounds to downcode to 23395 or deny for insufficient documentation.
See how Mira captures CPT 23397 documentation