Open tenotomy of the shoulder involving multiple tendons divided through a single incision.

Verified May 8, 2026 · 8 sources ↓

Medicare: $674.03
Total RVUs: 20.18
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCMdclarityGenhealthTdi

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 tendon divided by name (e.g., subscapularis, biceps long head, supraspinatus) — notes that say 'multiple tendons' without naming them are audit targets.
State the surgical approach and confirm all tendons were accessed through the same single incision to support the 23406 descriptor versus separate incisions.
Document the clinical indication linking the diagnosis (e.g., tendonitis, frozen shoulder, rotator cuff pathology) to the decision to release multiple tendons.
Record anesthesia type, patient positioning, intraoperative findings, and the closure technique used.
If performed with additional shoulder procedures on the same date, document that each service was distinct and medically necessary to support modifier 59 or XS use.
For modifier 22 claims, include a narrative explaining the increased complexity — number of tendons, adhesions, anatomic distortion, or operative time significantly beyond typical.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 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 23406 describes an open surgical tenotomy of the shoulder in which the surgeon cuts or releases multiple tendons through a single incision. This distinguishes it from 23405, which covers a single-tendon tenotomy through the same approach. The procedure targets conditions such as tendonitis, rotator cuff pathology, or frozen shoulder where releasing multiple tendon structures is necessary to restore function and reduce pain.

The surgeon makes an incision over the shoulder, identifies the affected tendons, and divides each one under direct visualization before closing the wound. Regional or general anesthesia is standard. Because multiple tendons are addressed through a single surgical access point, the code is not reported multiple times — one unit covers all tendons treated via that incision.

CPT 23406 carries a 90-day global period. All routine follow-up care, including post-op visits, dressing changes, and stitch removal, is included through day 90. Services unrelated to the shoulder tenotomy billed within that window require modifier 24 (E/M) or modifier 25 (same-day E/M before the procedure). The code is performed in both HOPD and ASC settings, with a meaningful payment differential between the two — see the Site of Service comparison on this page.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.73
Practice expense RVU	7.97
Malpractice RVU	1.48
Total RVU	20.18
Medicare national rate	$674.03
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	$674.03
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 23406 get rejected.

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

Operative note documents only a single tendon divided — payers downcode to 23405 without supporting language naming multiple tendons.
Bundling edits when billed same-day with arthroscopic shoulder codes without a modifier establishing a distinct open procedure.
Missing or vague diagnosis linkage — payer denies for lack of medical necessity when the clinical indication for multi-tendon release is not explicitly stated.
Unbundling flag when 23406 is billed with units greater than 1 — the code is one unit regardless of how many tendons were released through the single incision.
Global period violations — follow-up E/M visits billed without modifier 24 during the 90-day post-op window are denied as included services.

Frequently asked questions

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

01What separates 23406 from 23405?

23405 covers a single-tendon tenotomy through one incision. 23406 applies when multiple tendons are divided through that same incision. If the surgeon releases only one tendon, bill 23405 regardless of how many tendons were evaluated.

02Can 23406 be billed with arthroscopic shoulder codes on the same day?

It can, but expect NCCI scrutiny. If an open multi-tendon tenotomy is performed in the same session as shoulder arthroscopy, append modifier 59 or XS to 23406 with documentation that the open procedure was a distinct service not included in the arthroscopic work. Review current NCCI edits before billing — bundling relationships between open and arthroscopic shoulder codes change periodically.

03Is 23406 bilateral? How do I bill if both shoulders are addressed?

23406 is a unilateral procedure. If both shoulders are treated in the same session, bill two units with modifier 50, or bill the code twice using LT and RT on separate lines, per your payer's preference. Confirm bilateral coverage policy before submitting — some payers require prior authorization for bilateral shoulder surgery.

04How does the 90-day global period affect billing?

All routine post-op shoulder care is bundled through day 90. E/M visits for unrelated conditions need modifier 24. A same-day E/M that prompted the surgical decision needs modifier 57 if it was the decision-for-surgery visit, or modifier 25 for a separate significant evaluation. An unplanned return to the OR for a related problem during the global period uses modifier 78.

05Can a physical medicine and rehabilitation physician bill 23406?

PUF data shows PM&R as a top billing specialty for this code, but the procedure is open surgery requiring operative access. PM&R billing typically reflects physician-directed or supervised roles rather than independent performance of the open tenotomy. Confirm provider credentials, scope of practice by state, and payer enrollment status before submitting.

06When is modifier 22 appropriate for 23406?

Use modifier 22 when the procedure required substantially more work than usual — for example, dense adhesions, prior failed surgery, or an unusually high number of tendons requiring release. You must attach a written narrative to the claim explaining the increased complexity. Expect payers to request the operative report before paying the uplift.

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 name of each tendon divided, confirms all were accessed through a single incision, and records the surgeon's stated indication for multi-tendon release. This prevents the most common downcode scenario — notes that reference 'multiple tendons' generically without specifying which structures were cut — and provides the tendon-level detail auditors require to support 23406 over 23405.

See how Mira captures CPT 23406 documentation