Surgical reconstruction of the proximal humerus using an implant (hemiarthroplasty), including resurfacing techniques such as the Copeland or Global CAP prosthesis.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,087.87
Total RVUs: 32.57
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCPayerprice

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Diagnosis supporting medical necessity (e.g., glenohumeral osteoarthritis, avascular necrosis, post-traumatic arthritis, proximal humerus fracture sequelae)
Implant type and manufacturer identified by name (e.g., Copeland, Global CAP, Neer-style stem) — do not write 'standard prosthesis'
Surgical approach documented by name (e.g., deltopectoral, anterosuperior); notes that state only 'standard approach' are audit flags
Laterality explicitly stated in the operative note and on the claim
Failed conservative treatment documented in the pre-op record (physical therapy, injections, NSAIDs) with duration
If modifier 22 is appended, narrative must quantify increased work — added operative time, complexity, adhesions, prior hardware, or anatomic abnormality

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 52 Reduced services 58 Staged or related 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 23470 covers shoulder hemiarthroplasty — reconstruction of the proximal humeral joint using an implant. The code applies to both traditional hemiarthroplasty (where the humeral head is resected and replaced) and resurfacing hemiarthroplasty (Copeland, Global CAP), where the humeral head is capped rather than removed. CPT does not mandate a specific technique, so both approaches bill under 23470 without modifier 52. Do not downcode or use an unlisted code simply because the operative note lacks a head resection.

This is a high-complexity procedure with a 90-day global period. That global covers the day-before visit, the procedure itself, and all routine post-op care through day 90 — including wound checks, dressing changes, and suture removal. Any E/M service unrelated to the shoulder reconstruction billed in that window requires modifier 24. A significant, separately identifiable E/M on the same day as surgery requires modifier 25.

Bilateral shoulder hemiarthroplasty in the same session is exceedingly rare but would require modifier 50. Most claims carry LT or RT to identify laterality. Modifier 22 is appropriate when operative complexity substantially exceeds the typical procedure — document the added time, difficulty, or unusual anatomy explicitly in the operative note to support it.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	17.44
Practice expense RVU	11.57
Malpractice RVU	3.56
Total RVU	32.57
Medicare national rate	$1,087.87
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	$1,087.87
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$9,694.41

Common denial reasons

The recurring reasons claims for CPT 23470 get rejected.

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

Missing or mismatched laterality — claim lacks LT/RT modifier or it conflicts with the operative note
Medical necessity not established — no documentation of failed conservative treatment prior to surgery
Modifier 52 appended incorrectly for resurfacing hemiarthroplasty, triggering a reduced-payment denial or request for documentation
Routine post-op E/M billed without modifier 24 during the 90-day global period
Modifier 22 denied for lack of supporting narrative — operative note does not describe the specific factors that increased procedural complexity

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Does resurfacing hemiarthroplasty (Copeland, Global CAP) bill under 23470 or an unlisted code?

Bill 23470 with no modifier. CPT does not specify technique, so both traditional head-resection hemiarthroplasty and cap-style resurfacing use the same code. Appending modifier 52 or using an unlisted code is incorrect and will reduce or deny payment.

02What is the global period for 23470, and what does it include?

23470 carries a 90-day global. It covers the day-before preoperative visit, the procedure, and all routine post-op care through day 90 — wound checks, suture removal, and dressing changes. Bill unrelated E/M services in that window with modifier 24.

03When is modifier 22 justified for 23470?

When the procedure required substantially more work than typical — prior failed arthroplasty, severe deformity, significant adhesions, or unusually poor bone quality. The operative note must explicitly describe those factors and the additional time required. A bare modifier 22 without a supporting narrative will be denied.

04How does 23470 differ from 23472 (total shoulder arthroplasty)?

23470 replaces only the humeral side of the joint (hemiarthroplasty). 23472 replaces both the humeral head and the glenoid with a prosthetic socket (total shoulder arthroplasty). The operative note must confirm whether a glenoid component was implanted to select the correct code.

05Can 23470 and a rotator cuff repair code be billed together on the same day?

Potentially, but check NCCI procedure-to-procedure edits before billing both. If the cuff repair is a separate, distinct service not integral to the arthroplasty, modifier 59 or an X-modifier may apply. Document the cuff pathology and repair independently in the operative note.

06Is modifier 50 ever appropriate for 23470?

Bilateral simultaneous shoulder hemiarthroplasty is clinically rare. If performed in the same session, append modifier 50 and verify payer policy — some require two line items with LT and RT instead of 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 prosthesis name and manufacturer, surgical approach by name, laterality, intraoperative findings (bone quality, deformity, prior hardware), and estimated operative time from dictation. This prevents the two most common 23470 audit flags: an operative note that names only 'standard approach' and a claim missing LT/RT — both of which invite post-payment review and modifier disputes.

See how Mira captures CPT 23470 documentation