Open capsulorrhaphy of the shoulder with coracoid process transfer, performed anteriorly to address severe glenohumeral instability.

Verified May 8, 2026 · 7 sources ↓

Medicare: $977.31
Total RVUs: 29.26
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCLdhMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Operative note must name the specific procedure (Latarjet, Bristow-Latarjet) and explicitly describe coracoid process transfer to the anterior glenoid neck, not merely capsular plication
Preoperative imaging (MRI or CT) confirming glenohumeral instability pattern, glenoid bone loss, or Hill-Sachs lesion supporting the need for bony augmentation
Conservative management history: minimum duration of physical therapy, activity modification, or bracing trial with documented failure (required by most payers and NIA guidelines)
Laterality documented in both the operative note and on the claim — LT or RT modifier required; absence triggers automatic claim rejection at many MACs
Intraoperative findings describing the position and fixation of the coracoid transfer (screw fixation, suture anchors, or other hardware) and any capsular work performed
Functional limitation documented preoperatively — specific ADL or occupational restrictions support medical necessity and prior auth

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 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 23462 describes an open anterior capsulorrhaphy combined with transfer of the coracoid process to the anterior glenoid neck — the procedure most commonly known as the Latarjet or Bristow-Latarjet. The coracoid tip, along with its attached conjoined tendon and ligaments, is detached and fixed to the anterior glenoid, simultaneously restoring bony glenoid width and creating a dynamic sling that limits anterior translation. This is a structurally distinct operation from simpler capsular plication codes (23450, 23455, 23460), and the operative note must clearly document coracoid transfer — not just capsular tightening — to justify 23462.

The 90-day global period covers the surgery day, the day-before visit, and all routine postoperative care through day 90. Any E/M visit for an unrelated problem in that window requires modifier 24. A same-day E/M that drove the decision to operate requires modifier 57.

Prior authorization is nearly universal for this code given its clinical criteria requirements. Payers — including Medicaid managed care plans that use NIA/Evolent clinical guidelines — expect documented failure of conservative management, objective exam correlation with imaging, and confirmation that the instability pattern is consistent with a coracoid transfer rather than a soft-tissue-only repair.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	15.33
Practice expense RVU	10.67
Malpractice RVU	3.26
Total RVU	29.26
Medicare national rate	$977.31
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	$977.31
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 23462 get rejected.

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

Missing or vague coracoid transfer documentation — operative notes that describe only capsular tightening without explicit coracoid transfer will be downcoded to 23450 or 23455
Lack of prior authorization or insufficient conservative management documentation to satisfy payer clinical criteria under NIA/Evolent or similar UM programs
Missing laterality modifier (LT or RT) on the claim, which triggers an automatic edit at many MACs and commercial payers
Bundling conflicts when additional shoulder codes are billed same-day without a modifier establishing distinct procedural service — NCCI edits apply within the 23xxx family
ICD-10 diagnosis code does not match the clinical scenario for anterior instability requiring bony augmentation (e.g., using a generic dislocation code without a specificity-appropriate instability or bone-loss code)

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Is CPT 23462 the correct code for a Latarjet procedure?

Yes. The Latarjet and Bristow-Latarjet are both reported as 23462. The operative note must document transfer of the coracoid process to the anterior glenoid neck — that detail is what separates 23462 from 23450 (Putti-Platt/Magnuson type) or 23455 (capsular shift without transfer).

02Can I bill 23462 with other shoulder arthroscopy codes on the same day?

23462 is an open procedure. If a diagnostic arthroscopy is performed immediately before converting to open (a common sequence), check NCCI edits for the specific arthroscopy code pairing. Modifier 59 or XS may be needed to establish the distinct service, but CMS bundling policy generally absorbs a purely diagnostic scope into the open repair package. Document the decision to convert and the clinical reason.

03What global period applies to 23462?

90-day global. The surgery day, the day-before pre-op visit, and all routine postoperative care through day 90 are included. Unrelated E/M visits need modifier 24; the decision-for-surgery visit on the same day as the procedure needs modifier 57.

04Do I need a laterality modifier for 23462?

Always. Append LT or RT on every claim. Many MACs and commercial payers auto-deny shoulder procedure claims without a laterality modifier. Bilateral shoulder capsulorrhaphy on the same day is rare but would use modifier 50, billed on a single line.

05What ICD-10 codes pair with 23462?

Recurrent anterior glenohumeral instability codes are the primary drivers — look at M24.31x (pathological dislocation) and S43.0xx series for acute cases. For bone-loss-driven indications, specificity codes that capture glenoid deficiency or engaging Hill-Sachs lesions strengthen medical necessity. Avoid generic 'shoulder pain' codes, which will not satisfy payer clinical criteria for this procedure.

06When is modifier 22 justified for 23462?

When operative time and complexity substantially exceed the typical Latarjet — for example, a revision after prior failed Latarjet with hardware removal, significant scarring, or neurovascular proximity requiring extended dissection. The operative note must quantify the additional work: time, complexity factors, and why the case exceeded the standard. Without that, payers will ignore modifier 22 and pay the base rate.

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 procedure name (Latarjet, Bristow-Latarjet), the laterality, the coracoid transfer site description, and fixation method from the surgeon's dictation. It flags operative notes that describe capsulorrhaphy without an explicit coracoid transfer — the single most common reason 23462 gets downcoded to 23450 on audit. It also pulls laterality into the modifier field automatically, eliminating the missing-LT/RT rejection that accounts for a disproportionate share of first-pass denials on shoulder instability claims.

See how Mira captures CPT 23462 documentation