Manipulation of the shoulder joint performed while the patient is under anesthesia, with or without application of a fixation apparatus.

Verified May 8, 2026 · 5 sources ↓

Medicare: $184.71
Total RVUs: 5.53
Global, days: 10
Region: Shoulder

Drawn from CMSAAPC

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Primary diagnosis documented — adhesive capsulitis (M75.0x) or other shoulder pathology driving the need for manipulation under anesthesia
Type of anesthesia used (general, regional, MAC) and who administered it
Pre-procedure and post-procedure range-of-motion measurements in degrees for each plane (flexion, abduction, internal/external rotation)
Conservative treatment failures documented prior to MUA — physical therapy, injections, or home exercise program attempts and duration
Whether a fixation apparatus was applied post-manipulation, and if so, the type and positioning
Operative note signed by the performing surgeon confirming the manipulation was performed and clinical response achieved

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 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 23700 covers forceful manipulation of the shoulder joint — most commonly for adhesive capsulitis (frozen shoulder) — performed with the patient under general or regional anesthesia. Anesthesia is required to achieve the muscle relaxation necessary for effective capsular stretching and range-of-motion restoration that cannot be accomplished in an awake patient. The code also captures placement of a fixation apparatus if used post-manipulation to maintain position.

The global period is 10 days. That window covers the manipulation, immediate post-op care, and routine follow-up through day 10. Any E/M service for an unrelated condition within that window needs modifier 24. A same-day pre-operative decision E/M requires modifier 57 if the decision to perform the procedure was made that day.

When 23700 is billed on the same date as a shoulder injection (e.g., 20610), payers may bundle the injection as integral to the manipulation encounter. If the injection serves a distinct clinical purpose — such as post-manipulation corticosteroid administration for inflammation control — document that purpose explicitly and append modifier 59 or XS to the injection code. Payer edits on this pairing vary; verify NCCI edits before billing.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	2.51
Practice expense RVU	2.53
Malpractice RVU	0.49
Total RVU	5.53
Medicare national rate	$184.71
Global period	10 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	$184.71
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 23700 get rejected.

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

Lack of documented conservative treatment failure prior to manipulation under anesthesia — payers require evidence PT or injections were attempted first
Missing pre- and post-manipulation range-of-motion measurements, making medical necessity unclear
Same-day injection code (20610) bundled without modifier 59 or XS when billed alongside 23700
Anesthesia billed by the surgeon rather than a separate anesthesia provider — surgeon's anesthesia use is bundled into 23700
Insufficient diagnosis specificity — nonspecific shoulder pain codes denied when adhesive capsulitis or capsular contracture ICD-10 codes are required

Frequently asked questions

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

01Can I bill 23700 and a shoulder injection (20610) on the same day?

Yes, but expect a bundling edit. If the injection serves a distinct purpose — such as a post-manipulation corticosteroid injection for inflammation — document that clinical rationale clearly and append modifier 59 or XS to 20610. Without that separation, payers treat it as integral to the manipulation encounter.

02What is the global period for 23700?

Ten days. Routine post-op care through day 10 is included. Bill modifier 24 for unrelated E/M visits in that window, and modifier 57 if the decision to perform the MUA was made at a same-day pre-op visit.

03Does 23700 require general anesthesia, or can MAC or regional anesthesia qualify?

The code requires anesthesia — general, regional, or MAC all qualify. What matters is that the anesthesia enabled adequate muscle relaxation for effective manipulation. Document the anesthesia type and provider in the operative record.

04What diagnosis codes support 23700?

Adhesive capsulitis (M75.0- with laterality) is the primary driver. Capsular contracture and post-surgical shoulder stiffness also support the code. Nonspecific shoulder pain codes alone are routinely denied — use the most specific ICD-10 code that reflects the capsular pathology.

05If the surgeon performs 23700 and then brings the patient back for arthroscopy within the global period, how is the second procedure coded?

If the arthroscopy is unrelated to the manipulation (e.g., a new rotator cuff finding), append modifier 79. If it is a planned staged procedure, use modifier 58. Modifier 78 applies only to an unplanned return to the OR for a complication related to the original procedure.

06Can 23700 be billed bilaterally?

Yes. Bilateral shoulder manipulation requires modifier 50, or separate line items with LT and RT depending on payer preference. Verify with the specific payer — some require 50 on a single line, others want two lines with laterality modifiers.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures pre- and post-manipulation range-of-motion measurements in all planes, the type of anesthesia administered, the primary diagnosis driving the procedure, and documentation of prior conservative treatment attempts — all from dictation. This prevents the most common denial for 23700: medical necessity rejections tied to missing ROM data or undocumented conservative care failure.

See how Mira captures CPT 23700 documentation