Open repair of an acromioclavicular (AC) joint dislocation, acute or chronic, with fascial or other graft including graft harvest

Verified May 8, 2026 · 5 sources ↓

Medicare: $612.24
Work RVU: 8.6
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCMdclarityAbos

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Confirm AC joint dislocation grade and whether the presentation is acute or chronic, matching the ICD-10 diagnosis code
Identify graft type used (e.g., fascia lata, semitendinosus, allograft) and harvest site or source — this is what distinguishes 23552 from 23550
Describe fixation technique and implants: hook plate, endobutton, suture anchor, or other construct placed at the AC and/or coracoclavicular interval
Document incision approach, coracoclavicular ligament status, and any concomitant distal clavicle excision or coracoacromial ligament transfer if separately billable
Operative note must state that graft was harvested (or allograft prepared) and incorporated — vague references to 'graft augmentation' are insufficient for payer review

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 58 Staged or related 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 XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 23552 covers open surgical treatment of an AC joint dislocation — either acute (typically Rockwood grade III–VI presenting early) or chronic (delayed or failed conservative management) — when the reconstruction requires a graft. The graft harvest is bundled into the code; don't separately bill 20920 or 20922 for fascia lata harvest performed as part of this procedure.

The 90-day global period covers all routine postoperative care from the day before surgery through day 90. Separate E/M visits during that window require modifier 24 (unrelated medical problem) or modifier 25 doesn't apply post-operatively — modifier 24 is the correct tool for unrelated visits inside the global. Staged or planned return procedures use modifier 58; unplanned returns for a related complication use modifier 78.

Distinguish 23552 from 23550, which is the open AC repair without graft. Billing 23552 when no graft was harvested and used — or billing 23550 when a graft was employed — is a documentation mismatch that draws audit attention. The operative note must confirm graft type, harvest site, and fixation technique to support 23552 over 23550.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (8.6) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (18.33) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.6
Practice expense RVU	8.04
Malpractice RVU	1.69
Total RVU	18.33
Medicare national rate	$612.24
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	$612.24
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,669.23

Common denial reasons

The recurring reasons claims for CPT 23552 get rejected.

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

Code billed as 23552 but operative note describes no graft use — payer downcodes to 23550
Bundling of separate fascia lata harvest code (20920/20922) when graft harvest is already included in 23552
Missing or ambiguous laterality — shoulder codes require LT or RT on every claim line
Lack of medical necessity documentation for chronic presentation: no prior conservative treatment records or imaging supporting delayed surgical intervention
Concomitant arthroscopic procedure billed without modifier 59 or XS to bypass NCCI bundling edits

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What is the difference between 23550 and 23552?

23550 is open AC repair without graft. 23552 requires that a graft — autograft or allograft — was harvested or prepared and used to reconstruct the coracoclavicular or AC ligaments. If no graft was used, bill 23550. Upcoding to 23552 without documented graft use is an audit risk.

02Is fascia lata harvest separately billable with 23552?

No. Graft harvest is bundled into 23552 per the code's description. Separately billing 20920 or 20922 for the fascia lata harvest performed as part of this procedure will be denied as unbundled.

03Can 23552 be billed with a same-day distal clavicle excision (23120)?

Yes, AAPC forum discussions confirm 23120 can be billed alongside 23552 when a distal clavicle excision is separately performed and documented as a distinct service. Append modifier 51 to the lower-value code and verify no NCCI PTP edit applies for your payer.

04What modifiers are needed for a bilateral AC repair on the same day?

On a professional claim, append modifier 50 to 23552 and bill one line. For ASC facility claims, bill two lines — one with modifier LT and one with RT — each at one unit of service, per CMS NCCI guidance.

05How is the 90-day global period handled for post-op complications requiring return to the OR?

If the return procedure is related to 23552 and unplanned (e.g., hardware failure, infection washout), use modifier 78. If the return procedure is unrelated to the original AC repair, use modifier 79. Never use 78 and 79 interchangeably — payers audit this distinction.

06Does 23552 cover both acute and chronic AC dislocations?

Yes. The code descriptor explicitly includes acute and chronic presentations. The distinction matters for diagnosis coding and medical necessity documentation, not for which CPT code to use — both bill as 23552 when a graft is employed.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures graft source and type (autograft vs. allograft, fascia lata vs. tendon), harvest technique, fixation construct, and whether the dislocation was acute or chronic — directly from surgeon dictation. That specificity is what separates a clean 23552 claim from a 23550 downcode or a fascia-harvest unbundling denial on audit.

See how Mira captures CPT 23552 documentation