Open surgical division of a single tendon and associated muscle in the shoulder area, typically performed to relieve tension, correct painful conditions, or address congenital or acquired structural problems.

Verified May 8, 2026 · 7 sources ↓

Medicare: $574.50
Work RVU: 8.33
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCMdclarityEventsCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify the tendon divided by name (e.g., long head of biceps, subscapularis) — 'single tendon' alone is insufficient for audit purposes
Document the clinical indication: congenital vs. acquired condition, prior conservative treatment tried, functional deficit or pain level driving surgical decision
Confirm open approach with skin incision description; distinguish from percutaneous or arthroscopic technique, which maps to different codes
If performed alongside an arthroscopic procedure, document why the tenotomy was a separate, distinct service not encompassed by any debridement performed
Record intraoperative findings confirming pathology of the divided tendon and muscle, not just the pre-op diagnosis
Note laterality explicitly (left vs. right shoulder) to support LT/RT modifier assignment

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 52 Reduced services 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 24 Unrelated E/M during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 23405 describes an open tenotomy of the shoulder in which the surgeon incises or divides a single tendon — most commonly the biceps long head — through a skin incision to correct painful or dysfunctional shoulder conditions. The procedure addresses congenital deformities, acquired contractures, or degenerative pathology by releasing tensioned soft tissue. It is distinct from arthroscopic biceps tenotomy (reported under 29822/29823) and from biceps tenodesis (23430 open, 29828 arthroscopic).

A critical coding distinction: when arthroscopic debridement is performed and the biceps tendon is tenotomized as part of that debridement, CPT Assistant (September 2012) instructs coders to report only the debridement code based on extent of service — not 23405 separately. If you're billing 23405 alongside an arthroscopic shoulder code, document clearly that the tenotomy was a distinct, separately indicated procedure not subsumed by the debridement.

23405 carries a 90-day global period. All routine post-op visits, wound checks, and dressing changes through day 90 are bundled. Billing a separately identifiable E/M during the global window requires modifier 24. If a related unplanned return to the OR is needed during the global, append modifier 78. An unrelated procedure in the same global window uses modifier 79.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (8.33) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.2) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.33
Practice expense RVU	7.31
Malpractice RVU	1.56
Total RVU	17.2
Medicare national rate	$574.50
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	$574.50
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 23405 get rejected.

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

Bundling denial when billed same-day as arthroscopic shoulder debridement (29822/29823) without documentation that the tenotomy was a distinct, separately indicated service
Missing or incorrect laterality modifier — payers increasingly require LT or RT for unilateral shoulder procedures
Modifier 59 appended without supporting documentation that the tenotomy was performed at a separate anatomic site or distinct encounter from a bundled procedure
Global period conflict — post-op E/M claims submitted without modifier 24, triggering automatic denial as included in the 90-day global
Percutaneous approach documented in the operative note, which does not support the open tenotomy code; auditors flag the mismatch and may redirect to an unlisted code

Frequently asked questions

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

01Can I bill 23405 alongside an arthroscopic shoulder debridement on the same day?

Generally no. CPT Assistant (September 2012) states that when the biceps is tenotomized as part of an arthroscopic debridement, only the debridement code is reported. To bill 23405 separately, you need clear documentation that the tenotomy was a distinct, separately indicated procedure — not subsumed by the debridement — and modifier 59 or XS may be required to bypass the NCCI edit.

02What is the difference between 23405 and 29822/29823 for biceps tenotomy?

23405 is an open tenotomy through a skin incision. 29822 and 29823 describe arthroscopic shoulder debridement and are used when biceps tenotomy is performed arthroscopically as part of debridement. Using 23405 for an arthroscopic tenotomy is a miscoding — approach determines the code.

03When does a percutaneous shoulder tenotomy get billed as 23405 with modifier 52?

It's debated in the coding community. Some coders use 23405-52 for percutaneous tenotomy; others argue the unlisted code 23929 is more appropriate since the approach differs materially from the open procedure described by 23405. Check your MAC's guidance — there is no universal CMS ruling, and payer policies vary.

04Does the 90-day global on 23405 bundle the pre-op visit?

Yes. The day-before pre-op visit is included in the global. The decision-for-surgery visit on a separate date is separately billable with modifier 57. Routine post-op visits through day 90 are bundled; use modifier 24 for an E/M that addresses a problem unrelated to the tenotomy.

05How do I bill if the same tenotomy needs to be repeated during the 90-day global?

If the same surgeon performs a repeat tenotomy for a related reason during the global period, append modifier 78 (unplanned return to OR for related procedure). If the repeat procedure is unrelated to the original tenotomy, use modifier 79. Do not use modifier 76 or 77 without also considering whether the global period applies.

06Is 23405 ever billed bilaterally?

Bilateral shoulder tenotomy in one session is unusual but codable. Use modifier 50 and submit one unit of service. Alternatively, some payers want LT and RT on separate claim lines with modifier 51 on the second. Confirm your payer's bilateral billing preference before submitting.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the tendon name, surgical approach (open vs. percutaneous), laterality, intraoperative findings, and the clinical indication driving the tenotomy decision — all from dictation. That structured capture prevents the most common 23405 audit flag: operative notes that document a tenotomy during an arthroscopic case without explicitly distinguishing it from the debridement, which triggers bundling denials.

See how Mira captures CPT 23405 documentation