Open anterior capsulorrhaphy of the shoulder with labral repair, including procedures such as the Bankart repair, performed to correct anterior instability and reattach a torn labrum to the glenoid rim.

Verified May 8, 2026 · 8 sources ↓

Medicare: $880.45
Total RVUs: 26.36
Global, days: 90
Region: Shoulder

Drawn from CMSFastrvuGenhealthAAPCAAOS

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Imaging (MRI or MRI arthrogram) confirming anterior labral tear with or without capsular laxity
History of recurrent shoulder instability or dislocation with documented episode count and chronology
Conservative treatment failure — physical therapy duration, modalities tried, and outcome
Operative note naming the specific procedure (e.g., Bankart repair), approach, anchor type and count, capsular shift technique, and intraoperative findings
Documentation of laterality (left or right shoulder) on both the operative note and the claim
Pre-authorization approval number recorded in the file before surgery if payer requires it
If modifier 22 is used, a separate attestation paragraph explaining what made the work substantially greater than typical — e.g., dense adhesions, prior failed repair, extensive bone loss

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 LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 23455 describes an open anterior capsulorrhaphy of the shoulder that includes labral repair — most commonly a Bankart procedure. The surgeon reattaches the torn anterior labrum to the glenoid rim using suture anchors, then tightens the shoulder capsule to eliminate pathologic laxity and restore glenohumeral stability. This is the open-surgery counterpart to arthroscopic Bankart repair (29806/29807) and is selected when open access is required due to bone loss, prior failed arthroscopic repair, engaging Hill-Sachs lesions, or surgeon preference based on instability severity.

The 90-day global period covers all routine post-op management through day 90. Any E/M visit on the day of or day before surgery where the decision for surgery is made requires modifier 57. Unplanned returns to the OR for a related complication within the global period use modifier 78; unrelated procedures in the same window use modifier 79. If a concurrent procedure is performed on the same shoulder in the same session, check NCCI edits before appending modifier 59 — NCCI prohibits unbundling certain shoulder code pairs even with a distinct-service modifier.

Prior authorization is frequently required. Payers including POINT32 explicitly list 23455 under shoulder surgery prior authorization programs. Criteria typically include documented recurrent instability, failed conservative management, and imaging-confirmed labral pathology. Missing any one of these in the authorization request or operative record is a primary denial trigger.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	14.3
Practice expense RVU	9.33
Malpractice RVU	2.73
Total RVU	26.36
Medicare national rate	$880.45
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	$880.45
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 23455 get rejected.

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

Missing or expired prior authorization — many commercial payers require pre-auth for all open shoulder instability repairs
Laterality modifier (LT or RT) absent from the claim, triggering automated edit rejection
ICD-10 diagnosis does not specify instability or labral pathology — unspecified shoulder pain codes fail medical necessity review
Bundling conflict when 23455 is billed same-day with an arthroscopic shoulder code without adequate modifier and documentation support
Insufficient conservative treatment documentation — payers require evidence of failed PT before approving open stabilization
Global period violation — routine post-op E/M billed without modifier 24 within the 90-day window

Frequently asked questions

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

01What is the difference between CPT 23455 and arthroscopic Bankart codes 29806/29807?

23455 is an open procedure. Arthroscopic anterior capsulorrhaphy without labral repair is 29806; with SLAP repair it's 29807. Payers and NCCI treat the open and arthroscopic codes as distinct — you will not bill 23455 alongside 29806 or 29807 for the same shoulder at the same session.

02Can 23455 be billed with 23450 on the same day for the same shoulder?

No. 23450 (Putti-Platt/Magnuson type capsulorrhaphy) and 23455 (anterior capsulorrhaphy with labral repair) are alternative open procedures for the same anatomic target. Billing both for one shoulder in one session will trigger an NCCI edit denial.

03When is modifier 22 appropriate with 23455?

Use modifier 22 when documented circumstances — dense adhesions from prior surgery, significant glenoid bone loss requiring additional grafting steps, or a failed prior Bankart repair — substantially increased operative time and work beyond the typical case. The operative note must contain an explicit paragraph explaining why. A bare claim with modifier 22 and no supporting documentation will be denied or recouped on audit.

04Does 23455 require prior authorization, and which payers enforce it?

Yes, most commercial payers require prior authorization for open shoulder stabilization. POINT32 explicitly lists 23455 under its Hip/Knee/Shoulder prior authorization program. Verify auth requirements at the time of scheduling — not the day of surgery — and keep the approval number in the patient record.

05How does the 90-day global period affect post-op billing?

All routine follow-up visits, dressing changes, and suture removals through post-op day 90 are bundled into 23455. Bill a separate E/M only if it addresses a new or unrelated problem (modifier 24) or if a new surgical decision is made (modifier 57 applies only pre-operatively). An unplanned return to the OR for a related problem uses modifier 78; an unrelated procedure uses modifier 79.

06Is bilateral billing valid for 23455?

Bilateral shoulder Bankart repair in a single operative session is rare but codeable. Append modifier 50 and expect reimbursement capped at 150% of the single-procedure rate. Document separate indications for each shoulder clearly — payers will scrutinize bilateral shoulder instability surgery.

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 specific procedure name (Bankart repair vs. capsular shift), approach, number and placement of suture anchors, extent of labral detachment repaired by clock position, degree of capsular tightening, and intraoperative findings such as bone loss or prior anchor hardware. That detail prevents the two most common post-op audit flags: operative notes that reference only 'standard stabilization procedure' and modifier 22 claims lacking a documented reason for increased work.

See how Mira captures CPT 23455 documentation