Surgical fixation of the scapula to the thorax, anchoring the shoulder blade to adjacent rib or vertebral structures to correct positional deformity or winging.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $898.82
- Total RVUs
- 26.91
- 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 5 cited references ↓
- Operative note must name the fixation method and structures used for anchoring (rib, vertebra, or both)
- Diagnosis confirmed with imaging — document scapular position abnormality on preoperative X-ray or CT
- History of conservative management failure or clinical basis for surgical urgency
- If bone graft harvested, document donor site, graft type, and how it was used
- For FSHD or neuromuscular etiology, document the underlying diagnosis and its relationship to scapular winging
- Laterality must be explicit — left, right, or bilateral — in both the operative note and on the claim
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 5 cited references ↓
CPT 23400 covers open scapulopexy — a procedure that anchors the scapula to the thorax (rib or vertebral structures) to correct abnormal scapular position or motion. The most common indication is Sprengel's deformity, a congenital condition where one scapula sits abnormally high. It is also used for scapular winging refractory to conservative care, including cases associated with facioscapulohumeral muscular dystrophy (FSHD). Coders should note that scapulothoracic fusion with iliac crest bone graft — sometimes performed for FSHD-related winging — is also reported under 23400, as CPT contains no separate fusion code for this anatomic site.
The 90-day global period covers the surgery, the preoperative day-before visit, and all routine postoperative care through day 90. Any E/M visit for an unrelated condition during the global window requires modifier 24. A separately identifiable E/M on the day of surgery requires modifier 25. If bone graft harvest is performed, check whether it bundles under NCCI edits before reporting it separately.
This is a low-volume, high-complexity procedure. Payers may require prior authorization and detailed documentation of failed conservative management, imaging confirming scapular position, and a diagnosis code that aligns with the surgical indication. Sprengel's deformity maps to Q74.0; scapular winging without a congenital cause typically maps to M89.81x. ICD-10 specificity is a frequent audit trigger on this code.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 13.52 |
| Practice expense RVU | 10.5 |
| Malpractice RVU | 2.89 |
| Total RVU | 26.91 |
| Medicare national rate | $898.82 |
| 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 | $898.82 |
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 23400 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- ICD-10 code does not support medical necessity — mismatched or insufficiently specific diagnosis code for the reported indication
- Missing prior authorization — payers frequently require it for this low-volume reconstructive procedure
- Bundling of separately billed bone graft harvest when payer considers it integral to 23400
- Laterality absent or ambiguous on the claim, triggering editing or rejection
- Lack of documentation showing conservative treatment failure prior to surgical intervention
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01Is there a separate CPT code for scapulothoracic fusion with bone graft?
02What ICD-10 codes pair with 23400?
03Can 23400 be billed bilaterally?
04What does the 90-day global period cover for 23400?
05When is modifier 22 appropriate for 23400?
06Does 23400 require prior authorization?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02aapc.comhttps://www.aapc.com/codes/cpt-codes/23400
- 03mdclarity.comhttps://www.mdclarity.com/cpt-code/23400
- 04cms.govhttps://www.cms.gov/files/document/2026-medicaid-ncci-chapter-4-policy-manual.pdf
- 05cms.govhttps://www.cms.gov/files/document/04-chapter4-ncci-medicare-policy-manual-2025finalcleanpdf.pdf
Mira AI Scribe
Mira's AI scribe captures the fixation target (rib number, vertebral level, or both), the anchoring technique, laterality, any bone graft harvest details, and the explicit surgical indication — Sprengel's deformity, scapular winging, or neuromuscular etiology. Capturing these specifics at dictation prevents the two most common denials on 23400: ICD-10 mismatch and missing operative detail that auditors use to downcode or reject the claim.
See how Mira captures CPT 23400 documentation