Anterior capsulorrhaphy of the shoulder with bone block augmentation to stabilize a chronically unstable or recurrently dislocating glenohumeral joint.

Verified May 8, 2026 · 8 sources ↓

Medicare: $1,000.69
Total RVUs: 29.96
Global, days: 90
Region: Shoulder

Drawn from CMSMdclarityGenhealthLdhAAPC

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Diagnosis of recurrent anterior shoulder instability or dislocation, including failure of conservative treatment
Preoperative imaging (MRI or CT) confirming capsular laxity, labral pathology, or glenoid bone loss requiring bone block augmentation
Operative note specifying anterior open approach, capsulorrhaphy technique used, bone block source (e.g., iliac crest, coracoid), fixation method, and final position
Documentation of glenoid bone loss percentage or off-track Hill-Sachs lesion when bone block technique selection is based on bone deficiency
Laterality clearly stated in the operative report and on the claim (LT or RT)
If modifier 22 is appended, operative note must document specific factors increasing complexity and estimated additional operative time

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 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 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 23460 covers open anterior capsulorrhaphy of the shoulder performed with a bone block. The bone block — typically autograft harvested from the iliac crest or coracoid — is fixed to the anterior glenoid rim to extend the articular arc and physically limit pathologic anterior translation. This distinguishes 23460 from 23455 (capsulorrhaphy without bone block) and from purely arthroscopic stabilization approaches coded in the 29806 family. The procedure is indicated for recurrent anterior instability that has failed conservative management, particularly in patients with significant glenoid bone loss, off-track Hill-Sachs lesions, or prior failed soft-tissue repairs.

The 90-day global period covers the surgery date, the day-before visit, and all routine post-op care through day 90. Unrelated E/M services within that window require modifier 79; a return to the OR for a related complication (e.g., hardware failure, wound dehiscence) requires modifier 78. Laterality modifiers LT and RT are expected by most payers — omitting them on a unilateral shoulder procedure is a common clean-claim failure. When significantly increased operative complexity is documented (e.g., extensive adhesions, revision after prior Latarjet, complex bone graft shaping), modifier 22 may be supported, but the operative note must quantify the additional 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	15.42
Practice expense RVU	11.26
Malpractice RVU	3.28
Total RVU	29.96
Medicare national rate	$1,000.69
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	$1,000.69
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,339.27

Common denial reasons

The recurring reasons claims for CPT 23460 get rejected.

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

Missing laterality modifier — most payers auto-deny unilateral shoulder claims without LT or RT
Medical necessity not established — insufficient documentation of failed conservative treatment or absence of imaging confirming instability severity
Bundling conflict when 23460 is billed same-day with overlapping shoulder stabilization codes without appropriate modifier support
Modifier 22 appended without supporting operative note language quantifying increased work — payers return for documentation and then deny
Global period violations — post-op E/M billed without modifier 24 or 79, triggering automatic denial 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 23460?

23455 covers anterior capsulorrhaphy without bone block augmentation. 23460 is specifically for the version that includes a bone block — typically used when glenoid bone loss is significant enough that soft-tissue repair alone is insufficient to prevent re-dislocation.

02Can 23460 be billed for a Latarjet procedure?

The Latarjet (coracoid transfer) is frequently billed under 23460 because no dedicated CPT code exists for it. Document the coracoid transfer technique explicitly; payers familiar with the Latarjet will recognize 23460 as the correct vehicle, but the operative note must support the bone block element.

03Is a modifier required when billing 23460 on a unilateral shoulder?

Yes. Append LT or RT on every claim. Most commercial payers and Medicare contractors deny without a laterality modifier on shoulder procedure claims regardless of ICD-10 laterality coding.

04How does the 90-day global period affect post-op management billing?

All routine post-op visits, dressing changes, and related care through day 90 are bundled. Bill an unrelated E/M with modifier 79. If the patient returns to the OR for a related complication during the global, use modifier 78 — not 79. Inverting these modifiers is a common audit finding.

05When is modifier 22 justified for 23460?

Modifier 22 is defensible when the operative note documents specific complexity beyond the typical bone block capsulorrhaphy — such as revision after a prior failed Latarjet, extensive scarring requiring additional dissection time, or complex graft shaping. The note must state the additional time incurred; a general statement of 'difficult case' will not hold up on review.

06Can 23460 be billed bilaterally in a single session?

Bilateral anterior bone block capsulorrhaphy in one operative session is rare but codeable. Use modifier 50 and verify payer-specific billing format — some require two line items with LT and RT rather than a single line with modifier 50.

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 anterior approach, bone block source and fixation details, capsulorrhaphy technique, and laterality directly from surgeon dictation. It flags notes that reference only 'standard approach' or omit bone block harvest site — the two documentation gaps most likely to trigger a medical necessity review or a modifier 22 denial. Laterality is auto-populated on the claim from the dictated side.

See how Mira captures CPT 23460 documentation