Fusion · Shoulder

Surgical fusion of the glenohumeral joint using bone graft harvested from the patient's own body, permanently eliminating motion at the shoulder.

Verified May 8, 2026 · 5 sources ↓

Medicare: $1,182.39
Total RVUs: 35.4
Global, days: 90
Region: Shoulder

Drawn from CMSAetnaEvicoreAAPC

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify autograft harvest site (e.g., iliac crest) and confirm graft was used — distinguishes 23802 from 23800
Document indication: failed arthroplasty, septic arthritis, brachial plexus palsy, or advanced post-traumatic arthritis with contraindication to replacement
Record intended fusion position (degrees of abduction, forward flexion, internal rotation) and intraoperative confirmation of position
Describe fixation construct: plate type, screw count, and configuration
Document failure of prior conservative or surgical management and why arthroplasty is not appropriate
Include pre-op imaging (X-ray or CT) demonstrating glenohumeral joint destruction or bone stock deficiency

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 52 Reduced services 58 Staged or related 62 Co-surgeons 74 Discontinued post-anesthesia 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 23802 covers glenohumeral arthrodesis performed with autogenous bone graft. The surgeon resects articular cartilage, prepares opposing bony surfaces, positions the humerus in the functional fusion angle, and fixes the construct with internal hardware — plates, screws, or a combination. The autograft harvest (typically iliac crest) is included in the code; you do not bill a separate harvest code. The procedure is most commonly indicated for end-stage septic arthritis, brachial plexus palsy, failed shoulder arthroplasty with unrestorable bone stock, or post-traumatic arthritis when arthroplasty is contraindicated.

The companion code 23800 covers the same fusion without autogenous graft; selecting 23802 requires documentation that autograft was obtained and used. The 90-day global period covers all routine post-op management, hardware checks, and wound care through day 90. Separate E/M visits in that window require modifier 24 with documentation of a distinct, unrelated problem.

Prior authorization is nearly universal for this procedure — Aetna, Cigna, and many regional Medicaid managed care plans explicitly list 23802 and require documented failure of conservative measures, imaging evidence of joint destruction, and clinical justification for fusion over arthroplasty. Submit auth requests with operative planning notes, prior treatment history, and functional outcome scores.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	17.96
Practice expense RVU	13.61
Malpractice RVU	3.83
Total RVU	35.4
Medicare national rate	$1,182.39
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	$1,182.39
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI G2) Ambulatory surgical center (freestanding)	$6,804.43

Common denial reasons

The recurring reasons claims for CPT 23802 get rejected.

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

Missing prior authorization — nearly all commercial and managed Medicaid plans require precert for glenohumeral arthrodesis
Autograft harvest not documented, triggering downcode to 23800
Insufficient conservative treatment history in the record prior to fusion
Indication not supported — payer policy requires documented contraindication to arthroplasty before approving fusion
Global period violation — post-op E/M billed without modifier 24 and documentation of an unrelated condition

Frequently asked questions

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

01What's the difference between 23800 and 23802?

23800 is glenohumeral arthrodesis without autogenous graft. 23802 includes autograft harvested from the patient — iliac crest is most common. If you used allograft only, 23802 does not apply; use 23800 and report the allograft separately with the appropriate tissue code.

02Can I bill separately for the iliac crest bone graft harvest?

No. The autograft harvest is bundled into 23802 — the descriptor explicitly states 'includes obtaining graft.' Billing a separate harvest code will trigger an NCCI edit rejection.

03Does 23802 require prior authorization?

Yes, for virtually all commercial and managed Medicaid payers. Aetna and Cigna both have published policies requiring medical necessity review. Submit with imaging, operative planning notes, prior treatment records, and documentation of why arthroplasty is contraindicated.

04What global period applies, and what does it cover?

23802 carries a 90-day global. The day-before visit, the surgery day, and all routine post-op visits, dressing changes, and hardware checks through day 90 are included. Bill modifier 24 on any E/M for an unrelated problem during that window, with documentation supporting the unrelated nature of the visit.

05Can 23802 be billed with a simultaneous hardware removal or other shoulder procedure?

If you remove prior implants as part of the same session to prepare for arthrodesis, that work is typically included in the fusion code. If a separately distinct procedure is performed, append modifier 51 to the lower-valued code. If the additional procedure is unrelated and performed in the same session under unusual circumstances, document the additional work thoroughly and consider modifier 22 if operative time and complexity are significantly increased.

06Is the HOPD vs. ASC site-of-service difference significant for 23802?

Yes — the HOPD and ASC payment rates differ substantially. See the Site of Service comparison table on this page. That gap affects your facility contracting and prior-auth strategy, particularly when scheduling patients with high-deductible plans.

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 autograft harvest site, fusion position in degrees, fixation hardware details, and the clinical rationale for arthrodesis over arthroplasty directly from dictation. That specificity is what separates a clean 23802 claim from a downcode to 23800 or a medical-necessity denial — and it satisfies prior-auth documentation requirements before the claim ever leaves the practice.

See how Mira captures CPT 23802 documentation