Surgical removal of the entire upper extremity through the glenohumeral joint, separating the arm from the scapula and clavicle without cutting through bone.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,034.43
Total RVUs: 30.97
Global, days: 90
Region: Shoulder

Drawn from CMSCDCFindacodeAAPC

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Indication for disarticulation — tumor staging, vascular compromise, trauma extent, or infection severity — documented in the H&P and operative note
Confirmation that procedure was performed through the glenohumeral joint without transecting the scapula or clavicle, distinguishing 23920 from forequarter amputation (23900)
Operative note must name the specific dissection planes, tissue layers divided, and method of stump closure or flap creation
Any co-surgeon or assistant surgeon role documented separately with each provider's distinct intraoperative contribution described
Pre-authorization or medical necessity documentation for elective oncologic cases, including tumor board or multidisciplinary review where applicable
Post-op plan addressing prosthetic consultation, wound care, and pain management, supporting global period management

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 51 Multiple procedures 52 Reduced services 62 Co-surgeons 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 7 cited references ↓

CPT 23920 describes shoulder disarticulation — amputation of the entire upper limb at the shoulder joint. The humerus is separated from the glenoid fossa, and the arm is removed without transecting the scapula or clavicle. Indications include malignant soft tissue or bone tumors, severe trauma with nonreconstructible vascular injury, refractory infection, or advanced peripheral vascular disease. Because no bone is cut, this differs fundamentally from forequarter amputation (23900), which removes the arm, clavicle, and scapula together.

The 90-day global period covers the surgery, the day-before preoperative visit, and all routine post-op care through day 90. Separate E&M services during the global window require modifier 24. An unplanned return to the OR for a related complication — wound dehiscence, flap necrosis — bills with modifier 78. An unrelated procedure in the global window uses modifier 79.

Site of service matters here. HOPD and ASC payments differ substantially (see the Site of Service comparison table on this page). The procedure rarely appears in outpatient settings given its acuity, but when it does, correct facility designation drives reimbursement. Co-surgeon arrangements (modifier 62) or assistant surgeon billing (modifier 80 or AS) should reflect operative report documentation of each surgeon's distinct role.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	15.82
Practice expense RVU	11.79
Malpractice RVU	3.36
Total RVU	30.97
Medicare national rate	$1,034.43
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	$1,034.43
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 23920 get rejected.

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

Wrong code selected — 23900 (forequarter amputation) billed when procedure was limited to the glenohumeral joint without scapula or clavicle removal
Missing or vague operative note that fails to confirm disarticulation through the joint, triggering medical necessity review
Global period billing conflicts — E&M or procedure claims submitted in the 90-day window without required modifier 24, 78, or 79
Co-surgeon or assistant surgeon claims denied when operative documentation does not describe each provider's distinct role
Prior authorization not obtained for elective cases at facilities requiring it for major amputation procedures

Frequently asked questions

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

01What distinguishes 23920 from 23900?

23920 is disarticulation through the glenohumeral joint — no bone is cut. 23900 is forequarter amputation, which removes the arm along with the clavicle and scapula. If the scapula is resected, bill 23900, not 23920.

02Can modifier 50 be used with 23920?

Bilateral shoulder disarticulation is anatomically implausible in a single operative session. Modifier 50 has no practical application here. LT or RT should be appended when a laterality indicator is required by the payer.

03What modifier is required for a return to the OR for wound dehiscence after 23920?

Modifier 78 — unplanned return to the OR for a complication related to the original procedure during the 90-day global period. Modifier 79 is for unrelated procedures in the same global window.

04How do you bill when two surgeons each perform distinct portions of the disarticulation?

Both surgeons append modifier 62 (co-surgeons) to 23920. Each operative report must document that surgeon's specific distinct role — not just presence in the room. Payers may request both notes.

05Does the 90-day global period include prosthetic consultation or rehabilitation visits?

No. Prosthetic fittings, rehabilitation, and occupational therapy are separate services not included in the surgical global package. Only routine post-op wound care and follow-up directly related to the surgery are bundled.

06Is modifier 22 appropriate for an unusually complex disarticulation?

Yes, if the procedure required substantially more work than typical — extensive tumor involvement, prior radiation field, or severe infection requiring extra dissection time. Attach a cover letter with operative note detail; expect payer review and possible audit.

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 joint-level approach (glenohumeral disarticulation versus bone-transecting amputation), the surgical indication, flap or stump closure technique, and each surgeon's distinct intraoperative role from dictation. That specificity prevents the most common audit flag on 23920: an operative note that doesn't clearly distinguish disarticulation from forequarter amputation, which triggers downcoding or medical necessity review.

See how Mira captures CPT 23920 documentation