Revision of a prior total shoulder arthroplasty involving replacement or repair of either the humeral or glenoid component, with allograft use when required.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,440.25
Total RVUs: 43.12
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCZimmerbiometAetnaFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify which component was revised: humeral or glenoid — not both (use 23474 if both revised)
Document the indication for revision: loosening, wear, infection, instability, or mechanical failure with imaging correlation
State whether allograft was used, including graft source and how it was applied
Describe the condition of the explanted component and bone stock at time of surgery
Record surgical approach by name and any intraoperative findings that increased complexity (supports modifier 22 if applicable)
Include pre-operative imaging reports confirming implant failure or pathology to establish medical necessity

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 57 Decision for surgery 58 Staged or related 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

23473 covers single-component revision of a failed or problematic total shoulder arthroplasty — either the humeral stem/head or the glenoid — including allograft augmentation when bone loss demands it. Use this code when only one component is being revised. If both the humeral and glenoid components are revised in the same session, step up to 23474.

Indications driving revision include component loosening, polyethylene wear, periprosthetic infection, instability, mechanical failure, or malpositioning identified on imaging. The operative note must clearly state which component was revised, the condition of the explanted hardware, and whether allograft was used. Vague language like 'shoulder revision performed' is an audit flag and a denial trigger.

This code carries a 90-day global period. All routine post-op visits, wound checks, and related services through day 90 are bundled. Bill unrelated same-period E/M visits with modifier 24. Do not separately report 23334 or 23335 (prosthesis removal) alongside 23473 — removal of the failed component is inherent to the revision and CMS NCCI policy prohibits unbundling 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	24.38
Practice expense RVU	13.85
Malpractice RVU	4.89
Total RVU	43.12
Medicare national rate	$1,440.25
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	$1,440.25
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$9,390.23

Common denial reasons

The recurring reasons claims for CPT 23473 get rejected.

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

Medical necessity not established — missing imaging or clinical documentation showing implant failure or pathology
23334 or 23335 billed separately for prosthesis removal, which is bundled into 23473 per NCCI policy
23473 billed when both components were revised — should be 23474, triggering a code mismatch denial
Operative note fails to specify which component (humeral vs. glenoid) was revised, leaving payer unable to validate code selection
Routine post-op E/M visits billed without modifier 24 during the 90-day global period

Frequently asked questions

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

01When do I use 23473 vs. 23474?

23473 is for single-component revision — humeral or glenoid only. If the surgeon revises both the humeral and glenoid components in the same operative session, bill 23474 instead. Billing 23473 when both were revised is a code mismatch and will deny.

02Can I separately bill 23334 or 23335 for removing the old implant during a 23473 revision?

No. CMS NCCI policy explicitly bundles prosthesis removal (23334, 23335) into the revision codes 23473 and 23474. Billing removal separately will trigger an NCCI edit and deny.

03Is allograft use required to bill 23473?

No. The code description reads 'including allograft when performed' — meaning allograft is optional. You bill 23473 whether or not allograft was used. Document graft use if it occurred; absence of allograft does not disqualify the code.

04What modifier applies if the revision was substantially more complex than typical?

Append modifier 22 and include a cover letter or narrative explaining the increased work — severe bone loss, extensive scar tissue, unusually prolonged operative time, or complex reconstruction. Documentation must support the claim; payers will request the op note.

05What is the global period for 23473 and what does it include?

The global period is 90 days. It includes the surgery date, the day-before pre-op visit, and all routine post-operative care through day 90. E/M visits for unrelated conditions during this window require modifier 24 to bypass the global bundle.

06Can 23473 be performed in an ASC setting?

Yes. The procedure is payable in both HOPD and ASC settings. The site-of-service payment differential is significant — see the Site of Service comparison table on this page for current 2026 rates.

07Which ICD-10-CM codes are most commonly paired with 23473?

Common diagnoses include T84.010A–T84.098 series (mechanical complication of internal joint prosthesis), T84.50XA (infection of internal joint prosthesis), and M96.891 (other musculoskeletal disorders following prior procedure). The ICD-10 must reflect the documented reason for revision — payers cross-check code pairing for medical necessity.

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 revised component (humeral or glenoid), the failure mode documented intraoperatively, allograft use with source, bone stock quality, and surgical approach from the surgeon's dictation. This prevents the most common denial pattern for 23473: an operative note that says 'revision shoulder arthroplasty' without specifying which component — leaving coders guessing and payers rejecting.

See how Mira captures CPT 23473 documentation