Open release of the coracoacromial ligament, with or without acromioplasty, performed to relieve impingement or restore motion in a stiff or frozen shoulder.

Verified May 8, 2026 · 6 sources ↓

Medicare: $658.33
Total RVUs: 19.71
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm open surgical approach with explicit documentation of incision — do not use 'standard approach' language
Identify the coracoacromial ligament as the structure released, not generic 'shoulder ligament'
Note whether acromioplasty was performed and document bone resection if so
Document clinical indication: impingement syndrome, adhesive capsulitis, or frozen shoulder with failed conservative treatment
Record pre-op range-of-motion measurements and imaging findings supporting surgical necessity
If modifier 22 is appended, dictate specific factors increasing complexity (e.g., dense adhesions, prior surgery, calcific deposits) and estimated excess time

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 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 23415 covers open surgical release of the coracoacromial ligament — the structure running from the coracoid process to the acromion that, when contracted or thickened, contributes to shoulder impingement and frozen shoulder. The surgeon makes an incision to access and divide the ligament; acromioplasty (shaving the undersurface of the acromion) may be performed in the same session and is included when reported under this code. The 90-day global period applies, meaning all routine postoperative care through day 90 is bundled.

The open approach is what distinguishes 23415 from arthroscopic alternatives. If the procedure is performed arthroscopically, 29826 (subacromial decompression with coracoacromial release) is the correct code — not 23415. Auditors flag notes that describe only portal-based technique but bill 23415; an incision must be documented. If a planned open procedure is converted from an arthroscopic attempt, report only the open code per NCCI policy.

For bilateral same-session release, append modifier 50. For unrelated procedures performed during the 90-day global, use modifier 79. For a return to the OR for a related complication within the global, use modifier 78. Modifier 22 is supported when documented complexity — dense adhesions, prior hardware, significant scarring — substantially increases operative time and work.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9
Practice expense RVU	8.86
Malpractice RVU	1.85
Total RVU	19.71
Medicare national rate	$658.33
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	$658.33
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 23415 get rejected.

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

Open approach not clearly documented — arthroscopic technique described but 23415 billed
Medical necessity not established: no documented failure of conservative care (PT, injections, NSAIDs)
Bundling denial when billed same-day with arthroscopic shoulder codes without proper modifier
Wrong-side modifier missing on bilateral or laterality-specific claims
Modifier 22 submitted without supporting documentation of increased complexity in the operative note

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What is the difference between CPT 23415 and 29826?

23415 is the open coracoacromial ligament release requiring a skin incision. 29826 is the arthroscopic subacromial decompression with coracoacromial ligament release. If the operative note describes portal-based technique, bill 29826. An incision must be documented to support 23415.

02Is acromioplasty separately billable when performed with 23415?

No. Acromioplasty is included in 23415 per the code's descriptor ('with or without acromioplasty'). Billing a separate acromioplasty code in the same session for the same shoulder will be bundled and denied.

03What global period applies to 23415, and what does it include?

23415 carries a 90-day global. The day before surgery, the surgery itself, and all routine post-op visits, wound checks, and suture removal through day 90 are bundled. Bill unrelated services in the global window with modifier 79; related return-to-OR procedures get modifier 78.

04Can 23415 be billed bilaterally?

Yes. Append modifier 50 for same-session bilateral open coracoacromial release. Some payers require LT and RT on separate line items instead — verify your payer's preferred billing format before submission.

05What documentation supports modifier 22 on 23415?

The operative note must describe specific factors that increased work beyond the typical procedure — for example, dense adhesive capsulitis requiring extensive dissection, prior surgical scarring, or calcific deposits requiring additional debridement. Increased operative time alone is insufficient; dictate what made the case complex.

06If an arthroscopic procedure is converted to open, how should I bill?

Per NCCI policy, report only the open code (23415) when an arthroscopic attempt is converted. Do not separately bill a diagnostic or surgical arthroscopy code for the aborted arthroscopic portion.

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 surgical approach (open incision confirmed), the specific structure released (coracoacromial ligament), whether acromioplasty was performed, and any complexity factors such as adhesion density or prior surgical scarring. This prevents the most common audit flag for 23415 — notes that describe an arthroscopic or unspecified technique when an open code is billed — and supplies the modifier 22 support documentation at the time of dictation rather than during a retrospective audit.

See how Mira captures CPT 23415 documentation