Fusion · Shoulder

Surgical fusion of the glenohumeral joint using internal fixation to permanently immobilize the shoulder, without bone graft harvesting.

Verified May 8, 2026 · 7 sources ↓

Medicare: $946.58
Total RVUs: 28.34
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCEmednyMdclarityCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Diagnosis supporting arthrodesis (e.g., end-stage arthritis, failed arthroplasty, brachial plexus injury with flail shoulder) with corresponding ICD-10 code
Operative note naming fixation construct used (plate and screw configuration, blade plate, etc.) — generic 'standard fixation' language triggers audit flags
Documentation that no autogenous bone graft was harvested; if graft was taken, 23802 is the correct code
Joint position at time of fusion (abduction, flexion, internal rotation degrees) — functionally critical and payer-reviewable
Failed conservative management or prior surgical intervention documented in the chart, supporting medical necessity
Intraoperative imaging use (fluoroscopy) noted if applicable, to substantiate hardware placement accuracy

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 7 cited references ↓

CPT 23800 covers glenohumeral arthrodesis — open surgical fusion of the ball-and-socket shoulder joint using fixation hardware — when no autogenous bone graft is harvested. The joint surfaces are prepared and held in a functional position with plates, screws, or other fixation devices until bony union occurs. Indications include end-stage glenohumeral arthritis, failed total shoulder arthroplasty, severe rotator cuff arthropathy, brachial plexus injury with flail shoulder, or chronic instability not amenable to reconstruction. If the surgeon harvests autogenous graft at the same session, bill 23802 instead.

The 90-day global period covers the operative day, the day-before visit, and all routine postoperative care through day 90. Unrelated E/M visits within that window need modifier 24; a separately identifiable same-day E/M needs modifier 25. A planned staged procedure within the global uses modifier 58; an unplanned return to the OR for a related complication uses modifier 78; an unrelated OR return uses modifier 79.

Site of service matters significantly here. HOPD and ASC payment rates differ substantially — see the Site of Service comparison table on this page. Document the fixation method, joint position at fusion, and intraoperative fluoroscopy use in the operative note. Audit teams flag notes that omit the exact hardware construct or describe joint preparation in generic terms.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	14.36
Practice expense RVU	10.93
Malpractice RVU	3.05
Total RVU	28.34
Medicare national rate	$946.58
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	$946.58
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 23800 get rejected.

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

Code billed as 23800 when autogenous graft was harvested — should be 23802; downcoding or denial results
Medical necessity denial when chart lacks documentation of failed prior treatment or progressive functional loss
Unbundling denial when associated bone graft codes are billed separately without modifier 59/XS and clinical justification
Global period violation — postoperative E/M visits billed within 90 days without modifier 24 to flag unrelated service
ICD-10 mismatch — diagnosis code does not support glenohumeral fusion as appropriate intervention for that condition

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What is the difference between CPT 23800 and 23802?

23800 is glenohumeral arthrodesis without bone graft. 23802 is the same fusion with autogenous graft harvested at the same session, and it includes the graft harvest in the code — do not separately bill a graft harvest code when using 23802.

02Can 23800 be billed bilaterally?

Technically yes with modifier 50, but bilateral glenohumeral arthrodesis is exceedingly rare. If you're appending modifier 50, expect payer scrutiny and have strong clinical documentation supporting the necessity of bilateral fusion in the same session.

03What global period applies to 23800?

90-day global. The day-before preoperative visit, the operative day, and all routine post-op care through day 90 are bundled. Bill unrelated E/M visits with modifier 24, and a same-day separately identifiable E/M with modifier 25.

04When is modifier 22 appropriate for 23800?

Use modifier 22 when documented circumstances — severe deformity, prior hardware removal, significant scarring from failed arthroplasty — substantially increase operative time and complexity beyond the typical arthrodesis. The operative note must quantify the additional work; a vague statement of difficulty won't hold up to audit.

05Can two surgeons each bill 23800 with modifier 62?

Yes, if the complexity genuinely requires two surgeons performing distinct portions of the procedure simultaneously. Each surgeon bills 23800-62 and documents their specific role. Both operative notes must describe distinct contributions — not just presence in the room.

06Is fluoroscopy separately billable with 23800?

Intraoperative fluoroscopy used to confirm hardware placement is generally bundled into the surgical code and not separately billable under Medicare. Check payer-specific policies, as commercial payers vary on this.

07How does site of service affect payment for 23800?

HOPD and ASC payments differ meaningfully for this procedure — see the Site of Service comparison table on this page. The surgeon's professional fee is also adjusted based on facility versus non-facility setting, which affects your practice's net revenue depending on where the case is performed.

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 fixation construct (hardware type and configuration), joint position at fusion, confirmation that no autogenous graft was harvested, and the intraoperative imaging method from the surgeon's dictation. This prevents the most common audit trigger — operative notes that omit hardware specifics or fail to distinguish 23800 from 23802 — and builds the medical necessity record from diagnosis through intraoperative decision-making.

See how Mira captures CPT 23800 documentation