Open posterior capsulorrhaphy of the glenohumeral joint, performed with or without a bone block augmentation, to correct posterior shoulder instability.

Verified May 8, 2026 · 8 sources ↓

Medicare: $1,024.74
Total RVUs: 30.68
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCMdclarityEmednyNIH

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Document 'posterior capsulorrhaphy' explicitly — vague language like 'capsular repair' won't distinguish this from 23450 or 23466.
Specify whether a bone block was placed, the fixation method used, and donor/allograft source if applicable.
Record the instability pattern (posterior, recurrent dislocation, subluxation) and failure of prior conservative treatment including duration and modalities tried.
Note the surgical approach by name (e.g., posterior deltoid-splitting, infraspinatus-splitting) — audit teams flag operative notes that say 'standard posterior approach' without specification.
If bone block was omitted, document the clinical rationale to establish medical necessity for the capsulorrhaphy alone.
When billing same-day with an arthroscopic code, document distinct anatomic work and separate indications for each procedure.

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 50 Bilateral procedure 51 Multiple procedures 59 Distinct service 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 23465 describes an open surgical tightening of the posterior glenohumeral joint capsule, with the option to include a bone block for additional bony restraint. The procedure targets posterior shoulder instability — recurrent posterior dislocations or subluxations — that has failed conservative management. The surgeon exposes the posterior capsule, implicates redundant tissue with sutures to reduce capsular volume, and, when indicated, secures a bone block to the posterior glenoid rim to reinforce the bony constraint.

This code sits within the capsulorrhaphy family (23450–23466). 23465 is specifically posterior; its anterior counterpart with bone block is 23460. Multidirectional instability repaired by any capsulorrhaphy technique goes to 23466. When the procedure is performed arthroscopically and results in an unlisted claim, 29806 is sometimes used as the analogous open comparator — but note that NCCI bundles 29806 with 23465, so reporting both requires modifier 59 with solid documentation that two distinct procedures were performed at distinct anatomic sites.

The 90-day global period means all routine post-op visits, dressing changes, and stitch removals through day 90 are bundled. New or unrelated problems in that window require modifier 24 (E/M) or 79 (unrelated surgery). A return to the OR for a complication related to the capsulorrhaphy uses 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	15.89
Practice expense RVU	11.41
Malpractice RVU	3.38
Total RVU	30.68
Medicare national rate	$1,024.74
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	$1,024.74
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 23465 get rejected.

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

Claim coded as 23466 (multidirectional) when operative report only supports posterior instability — payers will downcode or deny without clear instability-pattern documentation.
Bundled with 29806 or 29807 when both are billed same-day without modifier 59 and distinct procedural documentation.
Missing conservative-treatment failure documentation, causing medical necessity denial under payer prior-auth policies.
Wrong laterality or absent LT/RT modifier when payer requires it, triggering claim suspension or rejection.
Global period billing conflict — routine post-op E/M billed without modifier 24, denied as included in the 90-day global.

Frequently asked questions

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

01What is the difference between 23465 and 23466?

23465 is strictly posterior capsulorrhaphy. 23466 covers capsulorrhaphy for multidirectional instability by any technique. If the operative report documents instability in multiple planes — anterior, posterior, and inferior — bill 23466. Posterior-only instability is 23465.

02Can 23465 and 29806 be billed together on the same date?

NCCI bundles 29806 with 23465. Billing both requires modifier 59 (or XS) and clear operative-report documentation that an arthroscopic procedure was performed at a distinct anatomic site or for a separate indication from the open posterior capsulorrhaphy. Expect scrutiny — document thoroughly before appending 59.

03Does it matter whether a bone block was actually placed?

No — 23465 covers the posterior capsulorrhaphy with or without bone block. Placement of the bone block doesn't change the code. It does change the operative complexity, which could support modifier 22 if the work was substantially greater than typical, but only with documentation to back it.

04What modifier applies if the patient returns to the OR during the 90-day global for a wound complication from the same surgery?

Use modifier 78 — unplanned return to the operating room for a procedure related to the original surgery during the global period. Do not use modifier 79, which is reserved for unrelated procedures in the global window.

05Is prior authorization typically required for 23465?

Most commercial payers require prior authorization for open shoulder stabilization procedures. Denials on PA grounds almost always trace back to incomplete conservative-treatment documentation. Submit physical therapy records, duration of symptoms, and imaging findings with the PA request.

06How does the site of service affect reimbursement for 23465?

HOPD and ASC payments differ substantially — see the Site of Service comparison table on this page. The physician's professional fee RVUs are the same regardless of setting, but the facility payment the patient encounters changes. For high-RVU procedures like this one, ASC vs. HOPD choice materially affects total episode cost.

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 instability pattern (posterior, recurrent dislocation vs. subluxation), the specific capsular technique performed, whether a bone block was placed and how it was fixed, the posterior surgical approach by name, and documented failure of conservative management. That prevents the most common denial path: a generic 'shoulder stabilization' note that can't be mapped to 23465 vs. 23466 on review.

See how Mira captures CPT 23465 documentation