Open surgical repair of a freshly torn rotator cuff, performed within a clinically acute timeframe following injury.

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

• Onset date and mechanism of injury establishing acuity — distinguish traumatic acute event from chronic degeneration
• Operative note must name the specific tendon(s) repaired (supraspinatus, infraspinatus, subscapularis, teres minor) and extent of tear (partial vs. full thickness)
• Surgical approach documented explicitly (e.g., deltoid-splitting, deltopectoral) — notes that say 'standard open approach' draw audit flags
• Anchor type, number, and placement location described in the operative report to support the complexity of the repair
• Pre-operative imaging (MRI or ultrasound) in the record confirming acute tear consistent with the injury timeline
• If modifier 22 is applied, a separate attestation explaining what made the procedure substantially greater than typical is required

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 ↓

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

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

Common denial reasons

The recurring reasons claims for CPT 23410 get rejected.

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

• Acute vs. chronic mismatch: clinical record shows a long-standing tear but 23410 (acute) was billed instead of 23412 (chronic)
• Wrong approach code: arthroscopic rotator cuff repair (29827) performed but 23410 submitted, or vice versa
• NCCI bundling conflict when 23410 is billed same-day with 23630 (ORIF greater tuberosity) without modifier 59 — the NCCI indicator is 1, meaning a modifier can bypass the edit, but it must be supported by documentation of distinct services
• Global period violation: post-op shoulder visits billed without modifier 24 during the 90-day global window
• Missing or insufficient laterality documentation when LT or RT modifier is required by the payer