Surgical tenodesis of the long head of the biceps tendon, anchoring it to the proximal humerus after debridement of the damaged tissue.

Verified May 8, 2026 · 6 sources ↓

Medicare: $696.41
Total RVUs: 20.85
Global, days: 90
Region: Shoulder

Drawn from AAOSKzanowBedrockbillingAAPCMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm diagnosis driving tenodesis — specify tendon pathology (e.g., degenerative tearing, impingement, SLAP), not just 'biceps pain'
Describe the tendon's condition at the time of debridement, including the extent and location of degenerative change or tearing
Document the fixation method and anatomic location of reattachment to the proximal humerus
Record that this is a tenodesis (reattachment), not a tendon transfer, to support code selection over 23395
If billing same-day with other shoulder codes, document each procedure as an independent, separately identifiable service with its own indication
For modifier 22, include operative note language quantifying increased time or complexity beyond standard tenodesis

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 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 23430 covers biceps tenodesis at the shoulder — specifically, detaching the long head of the biceps tendon from its origin, debriding the diseased segment, and securing it to the proximal humerus to restore stability and function. The procedure addresses pathology from chronic impingement, degenerative tearing, or SLAP lesions where the tendon is too compromised to repair in place. It is distinct from a tendon transfer (23395): any reattachment of the biceps tendon, regardless of fixation site — including into the pectoralis major — is correctly coded as 23430, not 23395.

The most important NCCI bundling trap with this code involves total shoulder arthroplasty (23472). Although the AAOS Global Service Data and CPT Assistant (July 2024) both state biceps tenodesis is NOT inherently part of shoulder replacement, NCCI edits bundle 23430 into 23472 for Medicare and all carriers following NCCI. You cannot separately bill 23430 with 23472 for those payers, even with a distinct diagnosis linked. For government payers, that work is included and non-separately reportable.

Debridement or preparation of the biceps tendon performed as part of the tenodesis is integral to 23430 and cannot be counted toward the threshold for extensive debridement (29823). When 23430 is billed alongside arthroscopic rotator cuff repair (29827), the preparation steps inherent to each code are not stackable to justify additional codes. Separate reporting requires independent, well-documented pathology.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.92
Practice expense RVU	8.94
Malpractice RVU	1.99
Total RVU	20.85
Medicare national rate	$696.41
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	$696.41
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,676.55

Common denial reasons

The recurring reasons claims for CPT 23430 get rejected.

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

Bundled into 23472 (total shoulder arthroplasty) under NCCI edits — 23430 is not separately payable with TSA for Medicare and NCCI-following payers
Miscoded as 23395 (tendon transfer) when the biceps was simply reattached at a different site — payers recode or deny 23395 when the operative note describes tenodesis
Biceps debridement/preparation billed as a separate service when it is integral to the tenodesis procedure
Missing or vague ICD-10 diagnosis linkage — payers deny when the biceps pathology code is absent or doesn't support surgical intervention
Modifier 59 applied without adequate documentation of a distinct procedural service when bundling edits exist with a co-billed shoulder code

Frequently asked questions

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

01Can I bill 23430 with 23472 (total shoulder arthroplasty)?

Not for Medicare or any payer following NCCI. An NCCI edit bundles 23430 into 23472, making separate billing non-payable regardless of whether you attach a distinct diagnosis. The AAOS GSD and CPT Assistant July 2024 both confirm biceps tenodesis is not inherently included in the shoulder replacement work — but NCCI overrides that for billing purposes.

02The surgeon reattached the biceps to the pectoralis major. Should I use 23395 or 23430?

Use 23430. Reattaching the biceps tendon to any site — including the pectoralis major — is a tenodesis. Code 23395 (tendon transfer) requires transfer of a muscle-tendon unit to restore a lost function, which is a fundamentally different procedure. Billing 23395 in this scenario is incorrect coding per KZA guidance and AAOS CCRC.

03Is bilateral biceps tenodesis of the shoulder realistic, and how do I bill it?

Bilateral same-session shoulder tenodesis is uncommon but not impossible. If performed, report 23430 with modifier 50, or on separate lines with LT and RT. Verify the payer's bilateral payment policy — some pay 150% of the single-procedure rate, others apply MPPR at 50% for the second side.

04Can I count the biceps debridement toward the three-structure threshold for 29823?

No. Debridement or preparation of the biceps tendon performed as part of the tenodesis is integral to 23430. Per AAPC coding forum guidance, it cannot be counted as one of the discrete structures debrided to justify 29823 alongside 23430 or 29827.

05What ICD-10 codes support 23430?

Common supporting diagnoses include M75.2 (bicipital tendinitis), S46.219A/S (biceps tendon tear at shoulder), and M75.1 (rotator cuff syndrome when concurrent). The biceps-specific pathology code must be listed and linked to 23430; a generic shoulder pain code alone will draw payer scrutiny.

06Does 23430 have a global period, and what does that include?

Yes — 23430 carries a 90-day global period. That covers the surgery, the day-before visit, and all routine post-op care through day 90. Unrelated E/M services in the global window need modifier 24. A new, distinct procedure in the global period needs modifier 78 (related) or 79 (unrelated).

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 tendon's pre-repair condition, the debridement extent, the fixation method, and the anatomic reattachment site directly from surgeon dictation. It flags operative note language that describes tenodesis but uses 'transfer' terminology — the single most common miscoding trigger auditors cite when 23395 is billed instead of 23430.

See how Mira captures CPT 23430 documentation