Diagnostic shoulder arthroscopy with optional synovial biopsy — visual inspection of the glenohumeral joint interior with or without tissue sampling.

Verified May 8, 2026 · 7 sources ↓

Medicare: $448.91
Total RVUs: 13.44
Global, days: 90
Region: Shoulder

Drawn from CMSCgsmedicareAAOSCoderoncall

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 diagnostic scope: symptoms, prior conservative treatment, and failed non-operative workup that justified arthroscopy over imaging alone
Operative note must name the portals used and all compartments or structures visualized — 'standard approach' flags audits
If synovial biopsy was taken, document the specific site sampled, method of collection, and that the specimen was sent to pathology
Confirm no therapeutic procedure was performed — if any surgical work was done, 29805 bundles into the therapeutic code and must not be reported separately
Pre-operative diagnosis and post-operative findings must both appear in the note to support diagnostic intent
For same-day E&M, document that the visit addressed a problem separate from the shoulder scope indication if billing modifier 25

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

29805 covers diagnostic arthroscopy of the shoulder joint, including the option to collect a synovial biopsy during the same scope entry. It is the base shoulder arthroscopy code — meaning when a therapeutic procedure is performed in the same session, 29805 bundles into the surgical code and is not reported separately. Bill 29805 only when the arthroscopy is truly diagnostic and no separately reportable surgical procedure is performed.

The 90-day global period applies. All related E&M visits, routine post-op care, and dressing changes from surgery through day 90 are included in the payment. If a same-day E&M covers a problem genuinely unrelated to the shoulder scope, append modifier 25. A decision-for-surgery E&M on the same day as a major procedure requires modifier 57, but given the 090 global, confirm the surgical classification before applying it.

Fluoroscopy performed during the arthroscopy is integral — do not separately bill imaging codes. If the same shoulder undergoes a separate, distinct therapeutic arthroscopic procedure at a different session, modifier 79 (unrelated) or 78 (related, unplanned return) applies depending on clinical context. For bilateral diagnostic shoulder arthroscopy, report a single line with modifier 50 for Medicare; ASCs report two lines with LT and RT.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.88
Practice expense RVU	6.35
Malpractice RVU	1.21
Total RVU	13.44
Medicare national rate	$448.91
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	$448.91
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 29805 get rejected.

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

29805 billed alongside a therapeutic shoulder arthroscopy code — the diagnostic scope bundles into the surgical code per NCCI PTP edits
Fluoroscopy or imaging guidance billed separately — it is integral to any arthroscopic procedure and not separately payable
Operative note lacks specific findings or uses generic language ('normal arthroscopy') without compartment-by-compartment detail, triggering medical necessity denial
Same-day E&M submitted without modifier 25, bundled into the global package
Bilateral procedure reported as two units without modifier 50 (Medicare) or without LT/RT on separate lines (ASC)

Frequently asked questions

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

01Can I bill 29805 alongside a surgical shoulder arthroscopy code like 29806 or 29807?

No. 29805 is the diagnostic base code and bundles into any surgical shoulder arthroscopy performed in the same session. Report only the therapeutic code. Per NCCI PTP edits, the column 2 code (29805) denies when the column 1 surgical code is present on the same claim for the same shoulder on the same date.

02When is 29805 the correct code to report on its own?

Bill 29805 when the arthroscopy is purely diagnostic — the surgeon scoped the shoulder, evaluated the joint (with or without biopsy), and performed no separately reportable therapeutic procedure. If the plan was diagnostic and an incidental finding led to a minor intervention, review NCCI edits for that specific add-on before unbundling.

03Does the synovial biopsy need to be separately coded?

No. The biopsy is included in the descriptor of 29805 ('with or without synovial biopsy'). Do not add a separate biopsy code. Document the site and confirm the specimen went to pathology.

04What modifier applies if the patient returns for an unplanned related shoulder procedure during the 90-day global?

Modifier 78 — unplanned return to the OR for a procedure related to the original surgery. Modifier 79 is for an unrelated procedure during the global. Do not invert these.

05Can fluoroscopy used during the shoulder arthroscopy be billed separately?

No. Per NCCI policy, fluoroscopy performed during any arthroscopic procedure is integral to that procedure. Billing a separate fluoroscopy code with 29805 will deny.

06How do I report bilateral diagnostic shoulder arthroscopy for Medicare?

Report one line with modifier 50 for Medicare Part B. For ASC billing, report two lines — one with LT and one with RT, each with one unit of service.

07Is a same-day E&M billable with 29805?

Only if it addresses a significant, separately identifiable problem unrelated to the decision to scope the shoulder. Append modifier 25. A different diagnosis is not required, but the note must clearly document the distinct reason for the E&M visit.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures portal placement, all glenohumeral structures visualized, specific findings per compartment, and — if performed — the biopsy site and tissue submitted. It also flags when any therapeutic work is documented so coders know to bundle 29805 into the appropriate surgical code rather than report it separately. That prevents the most common denial: billing the diagnostic base code alongside a therapeutic arthroscopy on the same shoulder.

See how Mira captures CPT 29805 documentation