Open resection or transplantation of the long head of the biceps tendon at the shoulder, performed to relieve pain and restore function by either removing the damaged tendon segment or reattaching it to a new bony anchor point.

Verified May 8, 2026 · 6 sources ↓

Medicare: $701.42
Total RVUs: 21
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCAbosAcgmeCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify whether resection or transplantation was performed — do not leave this ambiguous in the operative note.
Document the surgical approach by name (e.g., deltopectoral, mini-open); notes that say 'standard approach' flag audits.
Record the condition of the tendon at the time of surgery: degree of tearing, degeneration, or instability driving the decision to resect vs. transplant.
Include the new fixation site if transplantation was performed (e.g., proximal humerus, bicipital groove), with fixation method described.
Note any concurrent procedures performed during the same operative session, with separate dictation supporting independent medical necessity for each.
If modifier 22 is appended, the operative note must explicitly describe factors that made the work substantially greater than typical — adhesions, prior surgery, anatomical complexity.

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 57 Decision for surgery 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 23440 covers open surgical procedures on the long head of the biceps tendon at the shoulder — either resecting (cutting and removing) the tendon or transplanting it to a new point of fixation on the humerus. This is an open procedure, distinguishing it from arthroscopic biceps work. The key distinction within the biceps tendon code family: 23430 is tenodesis (securing the tendon in place without resection), 23440 is resection or transplantation, and 29828 is the arthroscopic biceps tenodesis equivalent. Billing the wrong code in this family is a common audit trigger.

The procedure carries a 90-day global period. All routine shoulder follow-up visits, dressing changes, and suture removals through day 90 are bundled — do not bill them separately. Services for unrelated conditions during the global require modifier 24. A new problem evaluated on the same day as surgery requires modifier 25 on the E/M. If a staged or planned additional procedure is performed after the initial surgery, use modifier 58; an unplanned return to the OR for a related complication uses modifier 78.

This code appears on the ABOS Orthopaedic Sports Medicine acceptable CPT list and in ACGME case log guidelines, confirming its relevance for fellowship-trained sports medicine and shoulder specialists. Payer prior authorization requirements vary — some commercial payers require conservative treatment failure documentation (physical therapy, injections) before approving open biceps tendon surgery.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.37
Practice expense RVU	8.46
Malpractice RVU	2.17
Total RVU	21
Medicare national rate	$701.42
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	$701.42
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,464.37

Common denial reasons

The recurring reasons claims for CPT 23440 get rejected.

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

Miscoding 23440 when 23430 (tenodesis without resection) or 29828 (arthroscopic tenodesis) is more accurate based on the operative report.
Missing prior authorization or failure to document conservative treatment failure before payer-required step therapy.
Unbundling concurrent shoulder procedures without appropriate modifiers or independent medical necessity documentation.
Global period violations — billing routine post-op E/M visits within the 90-day window without modifier 24.
Operative note does not distinguish open from arthroscopic approach, leading to payer downcoding to 29828.

Frequently asked questions

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

01What is the difference between CPT 23440 and CPT 23430?

23430 is tenodesis — the tendon is secured at a new location without resection. 23440 covers resection (cutting and removing the tendon) or transplantation (detaching and reattaching to a new bony site). If the op note shows no release or resection, 23440 is not supportable.

02Can 23440 and 29823 be billed together on the same day?

Arthroscopic debridement (29823) and open biceps tendon resection/transplantation (23440) can potentially be reported together if distinct, separately documented work was performed. Append modifier 51 to the lower-value code and verify NCCI edits — confirm modifier indicator status before submitting.

03When should modifier 58 be used versus modifier 78 for a return to the OR?

Modifier 58 applies to a staged or planned procedure during the global period. Modifier 78 applies to an unplanned return to the OR for a complication related to the original procedure. Never invert them — incorrect use of 78 vs. 58 is an audit flag.

04Does CPT 23440 require prior authorization from commercial payers?

Many commercial payers require prior authorization and documented failure of conservative management — typically physical therapy and possibly corticosteroid injections — before approving open biceps tendon surgery. Requirements vary by payer; verify before scheduling.

05Is 23440 an open or arthroscopic procedure?

23440 is an open procedure. The arthroscopic equivalent for biceps tenodesis is 29828. If the operative note documents an arthroscopic approach, 29828 is the correct code. Submitting 23440 for an arthroscopic case will result in a correctable coding error.

06What modifier applies if a surgeon performs 23440 on both shoulders in the same operative session?

Bilateral same-session procedures use modifier 50. Some payers instead require LT and RT on separate line items. Confirm the individual payer's bilateral billing preference before submitting.

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, the specific tendon pathology, and whether the procedure was a resection or a transplantation — including the new fixation site and method when applicable. That detail prevents the most common denial for this code: payer downcoding to 23430 or 29828 when the operative note is vague about what was actually done. The scribe also flags concurrent procedures so your coder can assess bundling risk before the claim goes out.

See how Mira captures CPT 23440 documentation