Revision of total shoulder arthroplasty involving removal and replacement of both the humeral and glenoid components, with allograft use when required.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,552.14
Total RVUs: 46.47
Global, days: 90
Region: Shoulder

Drawn from AAPCZimmerbiometUhcproviderCMS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative note must explicitly identify both the humeral and glenoid components as removed and replaced — notes that document only one component revised support 23473, not 23474.
State the indication for revision: component loosening, migration, instability, periprosthetic fracture, infection, or polyethylene failure, with corresponding ICD-10-CM codes to establish medical necessity.
Document whether allograft was used for bone deficiency, including graft source and application site — it is included in 23474 but must appear in the note to support the code.
Record the original implant type (standard anatomic total shoulder vs. reverse total shoulder) and manufacturer/lot numbers where applicable for implant registry and payer audit purposes.
Include pre-operative imaging (X-ray, CT) demonstrating component failure or bone loss to substantiate medical necessity for bilateral-component revision.
Note intraoperative findings that confirm both components were addressed — e.g., glenoid component extraction technique, humeral stem removal method, and bone preparation performed.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 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 6 cited references ↓

CPT 23474 covers revision total shoulder arthroplasty in which the surgeon removes and replaces both the humeral (proximal humerus) and glenoid (shoulder socket) components. This distinguishes it from 23473, which applies when only one component — humeral or glenoid — is revised. When both components are addressed in the same operative session, 23474 is the correct code regardless of whether the original construct was a standard total shoulder or a reverse total shoulder arthroplasty.

The clinical driver is typically a failed or loose prosthesis: component migration, periprosthetic fracture, instability, infection, or polyethylene wear. Allograft use for bone deficiency is included in the code and does not warrant a separate charge. The 90-day global period means all routine post-operative management through day 90 is bundled — any unrelated service in that window requires modifier 24 or 25 to bypass the global.

From a facility standpoint, 23474 maps to OPPS APC 5115 (Level 5 Musculoskeletal Procedures) with a J1 status indicator, meaning all covered Part B services on the same claim are packaged into the primary APC payment. ASC payment is also available. Inpatient cases typically land in MS-DRG 483 (Major Joint & Limb Reattachment Procedure of Upper Extremity with CC/MCC) or related DRGs depending on comorbidities.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	26.53
Practice expense RVU	14.56
Malpractice RVU	5.38
Total RVU	46.47
Medicare national rate	$1,552.14
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	$1,552.14
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$9,995.66

Common denial reasons

The recurring reasons claims for CPT 23474 get rejected.

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

Medical necessity not established: missing or inadequate pre-op imaging and clinical documentation showing why both components required revision.
Code billed as 23474 when only one component was revised intraoperatively — payers downcode to 23473 on audit if the operative note does not clearly describe bilateral-component removal and replacement.
Global period conflict: post-op E&M or related services billed without modifier 24 or 25 during the 90-day global, triggering automatic bundling denials.
Missing or mismatched ICD-10-CM diagnosis codes — payers require a supported diagnosis (e.g., T84.01XA periprosthetic fracture, T84.51XA infection, M96.821 loosening) that maps logically to revision of both components.
Site-of-service mismatch: facility and professional claims coded with different procedure codes or inconsistent component counts, flagging a discrepancy on payer review.

Frequently asked questions

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

01What is the difference between CPT 23473 and 23474?

23473 is billed when only one component — either the humeral or the glenoid — is revised. 23474 requires that both components are removed and replaced in the same operative session. The operative note must support both-component work to sustain 23474 on audit.

02Is allograft use billed separately when performed with 23474?

No. Allograft is explicitly included in the 23474 descriptor. Billing a separate graft code on the same claim is a bundling error and will be denied or recouped.

03Can 23474 be billed with 23473 on the same shoulder, same date?

No. If both components were revised, the correct code is 23474 alone. 23473 and 23474 are mutually exclusive for a single shoulder in a single operative session.

04What modifiers apply when 23474 is performed during the global period of a prior shoulder procedure?

Modifier 78 covers an unplanned return to the OR for a related procedure during the post-op period of the original surgery. Modifier 79 applies if the revision is unrelated to the prior procedure's global. Do not use 78 and 79 interchangeably — payers audit this distinction.

05Does 23474 require prior authorization with commercial payers?

Yes, for most commercial payers including UnitedHealthcare, revision shoulder arthroplasty falls under medical policy requiring prior authorization and InterQual-based medical necessity review. Confirm PA status before scheduling — retro-authorization is frequently denied.

06What ICD-10-CM codes most commonly support 23474?

Common supporting diagnoses include T84.010A–T84.019A (periprosthetic fracture around shoulder prosthesis), T84.51XA (infection of shoulder joint prosthesis), M96.821 (periprosthetic loosening), and Z96.611/Z96.612 for presence of existing prosthesis. The diagnosis must align with bilateral-component failure.

07Is 23474 performed in an ASC, and does it reimburse differently than HOPD?

23474 is payable in the ASC setting. HOPD and ASC payments differ — see the Site of Service comparison table on this page. Both settings map to APC 5115 under OPPS, with J1 status indicator meaning ancillary services are packaged into the primary APC at the facility level.

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 surgeon's dictation of component-level detail — which components were extracted, bone preparation performed, allograft application, and final implant placement for both the humeral and glenoid sides. It flags operative notes that describe only a single-component revision, prompting the coder to verify 23473 vs. 23474 before claim submission. That single check prevents the most common audit-driven downcode on shoulder revision claims.

See how Mira captures CPT 23474 documentation