Incision and drainage of a deep abscess or hematoma located in the upper arm or elbow region

Verified May 8, 2026 · 6 sources ↓

Medicare: $381.10
Work RVU: 2.92
Global, days: 10
Region: Shoulder

Drawn from CMSAAPCAAOSAoassnEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify depth of collection: document that the abscess or hematoma is deep to the investing fascia, not superficial
Describe the anatomic location precisely — upper arm versus elbow — and laterality (left or right)
Document the surgical approach: incision size, planes entered, volume/character of material drained, and wound management at close
Record any culture specimens sent, drain placement, and packing if used
Pre-op diagnosis supported by clinical findings or imaging; note any prior failed conservative 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 25 Significant separate E/M 51 Multiple procedures 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 6 cited references ↓

CPT 23930 covers surgical incision and drainage of a deep-seated abscess or hematoma in the upper arm or elbow. 'Deep' here means the collection is below the investing fascia — not a simple superficial skin abscess. The procedure requires entering the deeper soft tissue planes to adequately evacuate the infected or hemorrhagic material, which distinguishes it from the superficial counterpart (23931).

The 10-day global period means routine post-op visits within that window are bundled. If you're managing a new, unrelated problem during that 10-day window, append modifier 24 to the E/M. If the patient returns to the OR within the global for an unplanned procedure related to the original I&D — such as re-drainage of a recollecting hematoma — use modifier 78. An unrelated return-to-OR procedure in the global period takes modifier 79.

When 23930 and 23931 appear on the same claim, 23930 carries the higher RVU and should be listed first. Payer edits treat them as mutually exclusive at the same anatomic site; if both are legitimately performed at distinct sites on the same extremity, modifier 59 or XS supports separate reporting with documentation to back it up.

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 (2.92) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (11.41) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.92
Practice expense RVU	7.88
Malpractice RVU	0.61
Total RVU	11.41
Medicare national rate	$381.10
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	$381.10
HOPD (APC 5073) Hospital outpatient department	$2,967.63
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,248.36

Common denial reasons

The recurring reasons claims for CPT 23930 get rejected.

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

Claim bundled with 23931 when both are billed at the same site without a distinct-site modifier and supporting documentation
Depth not documented — payer downcodes to 23931 (superficial) when the operative note fails to confirm sub-fascial location
Laterality missing from claim or mismatched between claim and operative note, triggering edit or rejection
E/M visit during the 10-day global billed without modifier 24 for an unrelated problem, resulting in denial as bundled post-op care
Medical necessity denied when imaging or clinical documentation doesn't establish a discrete deep fluid collection requiring surgical drainage

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What separates 23930 from 23931?

Depth. CPT 23930 applies when the abscess or hematoma is deep to the investing fascia of the upper arm or elbow. CPT 23931 covers superficial collections. The operative note must state that the surgeon entered deep to fascia — not just 'the arm' — or a payer will downcode to 23931.

02Can 23930 and 23931 be billed together on the same date?

Only if the procedures were performed at genuinely distinct anatomic sites on the same visit. Payers treat them as mutually exclusive at a single site. If both are legitimately done at separate locations, list 23930 first (higher RVU), append modifier 59 or XS to 23931, and document separate sites in the operative note.

03What global period applies, and what does it include?

23930 carries a 10-day global period under CMS. That bundles the surgery and all routine follow-up through day 10. Wound checks, suture removal, and dressing changes in that window are not separately billable. An E/M for a new, unrelated problem requires modifier 24.

04If the patient returns to the OR within 10 days because the hematoma has re-accumulated, which modifier applies?

Modifier 78 — unplanned return to the OR for a procedure related to the original surgery during the global period. Do not use modifier 79, which is reserved for an unrelated procedure. Modifier 58 applies to staged or planned subsequent procedures, not unexpected returns.

05Is modifier 22 ever appropriate for 23930?

Yes, when the work is substantially greater than typical — for example, an unusually extensive or multiloculated deep abscess requiring significantly more operative time and complexity. Documentation must describe the specific factors that increased the work, not just note that the case was 'difficult.'

06Does site of service affect reimbursement for 23930?

Yes. HOPD and ASC payment rates differ meaningfully from the office rate under the CMS Physician Fee Schedule 2026. See the Site of Service comparison table on this page for current figures. Billing the wrong place-of-service code is an audit trigger and can result in overpayment recoupment.

Sources & references

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

Mira Scribe

Mira's AI scribe captures depth of dissection (sub-fascial versus superficial), precise anatomic site (upper arm versus elbow), laterality, volume and character of material drained, drain or packing placement, and culture specimens obtained. That documentation directly defends against downcoding to 23931 and supports medical necessity if a payer requests records.

See how Mira captures CPT 23930 documentation