Open surgical repair of a chronic rotator cuff tear — one or more tendon components, with the tendon secured into bone via suture through drilled holes or anchors.

Verified May 8, 2026 · 7 sources ↓

Medicare: $791.60
Total RVUs: 23.7
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCZimmerbiometCodingbooks

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify 'chronic' in the operative report — use terms like fraying, thinning, degenerative changes, or fatty infiltration; absence of these flags acute vs. chronic ambiguity on audit.
Identify which rotator cuff components were torn (supraspinatus, infraspinatus, subscapularis, teres minor) — if all four are torn, 23420 may apply instead.
Document the repair technique explicitly: bony trough preparation, suture anchor placement, sutures through drilled holes, side-to-side tendon repair.
If acromioplasty was performed, note it in the operative report — but do not bill it separately; it is included in 23412.
Record the surgical approach by name (deltoid-splitting, anterior, superior) — auditors flag notes that say only 'standard approach'.
If the case began arthroscopically before converting to open, document the reason for conversion and the scope of arthroscopic work performed.

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 62 Co-surgeons LT Left side RT Right side 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

23412 covers open repair of a chronically torn rotator cuff. Chronic tears are characterized by fraying, thinning, or degenerative changes rather than a discrete traumatic event. One or more of the four rotator cuff components may be involved. The operative technique typically involves burying the supraspinatus tendon into a bony trough on the humeral head and securing it with sutures passed through drilled holes, then completing side-to-side repair to adjacent tendons. Acromioplasty is included in the procedure and cannot be billed separately.

Do not confuse 23412 with 23420. Use 23420 only when all four rotator cuff components are torn and the approach is reconstruction rather than repair — 23420 also includes acromioplasty by definition. For a partial or single-component chronic tear repaired open, 23412 is correct. For an acute tear repaired open, use 23410. If surgery begins arthroscopically and converts to open, report only 23412 — not the arthroscopic code alongside it. Modifier 22 may be appended to reflect the additional arthroscopic work performed before conversion.

23412 carries a 90-day global period. All routine post-op care, dressing changes, and related visits through day 90 are bundled. Unrelated problems billed in that window require modifier 24 on E/M services or modifier 79 on unrelated procedures. Site of service matters: the HOPD and ASC payment rates differ significantly — see the Site of Service comparison table 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	11.63
Practice expense RVU	9.66
Malpractice RVU	2.41
Total RVU	23.7
Medicare national rate	$791.60
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	$791.60
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 23412 get rejected.

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

Acute vs. chronic not distinguished in the operative note — payer downcodes to 23410 or requests medical records to adjudicate.
Acromioplasty billed separately (e.g., 23130) alongside 23412 — it is included and will be bundled or denied.
Arthroscopic code (29827 or 29826) reported on the same claim when the case converted to open — report only the open code, with modifier 22 if warranted.
Missing or inadequate documentation of chronicity — no mention of fraying, degenerative changes, or prolonged symptom history triggers medical necessity denial.
Post-op E/M or related procedure billed in the 90-day global period without modifier 24 or 79.

Frequently asked questions

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

01What distinguishes 23412 (chronic) from 23410 (acute)?

Chronicity is a clinical determination made by the surgeon, not a fixed time threshold. Chronic tears show degenerative changes — fraying, thinning, fatty infiltration. Acute tears result from a discrete traumatic event. If the operative note doesn't specify, coders should check the H&P for history of trauma vs. gradual onset. Do not default to one or the other without documentation support.

02When should I use 23420 instead of 23412?

23420 requires all four rotator cuff components to be torn and the operative approach to be reconstruction rather than repair. It also includes acromioplasty. If fewer than four components are involved, or if the surgeon repaired rather than reconstructed, 23412 is the correct code.

03Can I bill acromioplasty separately when performed with 23412?

No. Acromioplasty is included in 23412 by AAOS global service data. Billing it separately — whether as 23130 or an arthroscopic equivalent — will result in a bundle edit denial.

04The surgeon started arthroscopically and converted to open. What do I bill?

Bill only the open code, 23412. Do not add 29827 or 29826. If the arthroscopic portion involved significant additional work, append modifier 22 to 23412 with supporting documentation of the increased complexity.

05What modifiers apply when billing 23412 on both shoulders same session?

For a physician claim, report 23412 with modifier 50 on a single line. For an ASC, report two lines — one with modifier LT and one with modifier RT. Check payer-specific rules; some commercial payers require LT/RT on separate lines regardless of setting.

06Is a same-day E/M billable with 23412?

Only if the E/M represents a significant, separately documented decision — for example, the decision to perform surgery made at a separately identifiable visit. Append modifier 57 to the E/M when it represents the decision for major surgery. Modifier 25 is for minor procedures with a 0- or 10-day global, not for 23412's 90-day global.

07Does 23412 require prior authorization?

Many commercial payers — including those following POINT32 and Cigna site-of-care policies — require prior authorization for shoulder surgery. Cigna also has a site-of-care policy directing select musculoskeletal procedures to outpatient settings. Confirm authorization requirements before scheduling.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures chronicity indicators directly from dictation — fraying, thinning, degenerative tissue quality, fatty infiltration, duration of symptoms — and flags the specific rotator cuff components repaired, the fixation technique (suture anchor, transosseous, side-to-side), and whether an acromioplasty was performed. This prevents the most common audit trigger for 23412: an operative note that doesn't establish chronicity or documents acromioplasty without noting it's included in the primary code.

See how Mira captures CPT 23412 documentation