Open anterior capsulorrhaphy of the shoulder using the Putti-Platt or Magnuson-type technique to eliminate pathologic laxity and restore glenohumeral stability.

Verified May 8, 2026 · 8 sources ↓

Medicare: $871.76
Total RVUs: 26.1
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCMdclarityHealthcareinspiredllcRise

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Operative note must name the specific technique performed (Putti-Platt or Magnuson-type) — 'standard capsulorrhaphy' is an audit flag
Document that the approach was open, not arthroscopic; arthroscopic capsulorrhaphy maps to 29806, not 23450
Laterality (right vs. left shoulder) must be specified to support RT or LT modifier
Pre-operative diagnosis with documented instability history — recurrent dislocation, failed conservative management, or traumatic etiology supports medical necessity
Confirm no coracoid transfer or labral reattachment was performed; either finding changes the correct code to 23462 or 23455 respectively
ICD-10-CM diagnosis code must be laterality-specific (e.g., M24.311 right, M24.312 left) to match the procedure side

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 58 Staged or related 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 23450 covers an open anterior capsulorrhaphy — specifically the Putti-Platt or Magnuson-type operation — performed to treat recurrent anterior shoulder instability. The surgeon tightens and implicates the anterior capsular tissue to reduce hyperlaxity and prevent further dislocation events. This is an open procedure; arthroscopic capsulorrhaphy is separately reported under 29806.

One important clinical context: coding experts note that the Putti-Platt and Magnuson-Stack procedures are now largely archaic techniques. Modern open instability surgery has shifted toward the Bankart procedure (23455) or coracoid process transfer/Latarjet (23462). If your operative note describes a coracoid transfer or labral reattachment, 23450 is not the right code. When the operative note is ambiguous, query the surgeon before billing.

The 90-day global period covers all routine post-op visits, dressings, and cast/splint management through day 90. First cast application is included; replacement casting during or after the global period may be reported separately. Unrelated procedures during the global require modifier 79; unplanned return for a related complication requires modifier 78.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	13.36
Practice expense RVU	9.89
Malpractice RVU	2.85
Total RVU	26.1
Medicare national rate	$871.76
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	$871.76
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,682.29

Common denial reasons

The recurring reasons claims for CPT 23450 get rejected.

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

Missing laterality modifier (RT or LT) — payers require side identification for all bilateral-structure procedures
Procedure billed as 23450 when operative note describes a Bankart repair (labral reattachment), which maps to 23455
Medical necessity denied because documentation lacks history of conservative treatment failure or recurrent dislocation episodes
Code billed with arthroscopic approach documented in the operative note — arthroscopic capsulorrhaphy belongs under 29806
ICD-10 diagnosis code too nonspecific or mismatched to the operative side, triggering medical necessity review

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01What is the difference between CPT 23450 and 23455?

23450 covers the Putti-Platt or Magnuson-type open capsulorrhaphy — pure capsular tightening without labral reattachment. 23455 is the Bankart procedure, which includes labral repair to the glenoid rim. If your surgeon reattached the labrum, bill 23455, not 23450.

02Can I bill 23450 for an arthroscopic capsulorrhaphy?

No. Arthroscopic capsulorrhaphy is reported with 29806. CPT 23450 is strictly an open procedure. Using 23450 for an arthroscopic case will draw audit scrutiny and likely result in a denial or downcode.

03Is 23450 still commonly performed?

Rarely. The Putti-Platt and Magnuson-Stack techniques described by this code are largely historical. Most open anterior instability surgery today uses the Bankart (23455) or Latarjet/coracoid transfer approach (23462). Confirm the technique with the surgeon before assigning 23450.

04What ICD-10 codes pair with 23450?

Recurrent anterior shoulder dislocation or subluxation codes are the typical pairing — use laterality-specific codes such as M24.311 (pathological dislocation, right shoulder) or M24.312 (left shoulder). Nonspecific instability codes increase medical necessity denial risk.

05Does the 90-day global include the initial cast or splint?

Yes. First cast or splint application at the conclusion of the procedure is included in 23450's global. Replacement casting during or after the global period may be reported separately with the appropriate casting code.

06When should modifier 22 be appended to 23450?

Use modifier 22 when the work was substantially greater than typical — for example, a revision case with extensive scar tissue requiring significantly more dissection time. The operative note must document the specific factors that increased complexity; a generic statement is insufficient for payer acceptance.

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 named surgical technique (Putti-Platt or Magnuson-type), the open approach confirmation, operative laterality, degree of capsular laxity addressed, and any additional structures encountered. This prevents the most common 23450 denial: a vague operative note that fails to distinguish this procedure from 23455 (Bankart) or 23462 (coracoid transfer), which forces a surgeon query post-submission and delays payment.

See how Mira captures CPT 23450 documentation