Arthroscopic surgical repair or tightening of the shoulder joint capsule to correct instability or recurrent dislocation.

Documentation requirements

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

Source · Editorial brief grounded in 11 cited references ↓

• Diagnosis establishing medical necessity — recurrent dislocation, instability, or capsular laxity — with supporting imaging (MRI) and failed conservative treatment where applicable.
• Arthroscopic approach confirmed in the operative note; 'standard approach' language without specifics is an audit flag.
• Anatomical location of capsular repair (anterior, posterior, inferior, or combination) with technique detail — number and type of suture anchors, fixation method, and confirmation of secure fixation.
• Laterality documented explicitly in the operative note and on the claim (LT or RT modifier); missing or mismatched laterality is a leading denial trigger.
• If modifier 22 is appended for a 360-degree or otherwise extensive repair, the note must quantify increased work: additional portals used, extra anchors placed, prolonged operative time, and severity of labral pathology.
• If 29806 and 29807 are billed together, the note must document that capsulorrhaphy and SLAP repair were performed in anatomically separate compartments of the joint.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

What this code covers

Source · Editorial summary grounded in 11 cited references ↓

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

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

Common denial reasons

The recurring reasons claims for CPT 29806 get rejected.

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

• Missing or non-specific laterality — claim submitted without LT or RT modifier, or operative note and claim laterality conflict.
• Medical necessity not established — no documented failed conservative treatment, inadequate imaging correlation, or vague instability description.
• NCCI bundling with 29807 — pairing rejected without modifier 59 on 29807, or payer does not accept the modifier override without documented separate anatomical regions.
• Operative note too brief or generic — lacks anchor count, technique specifics, or capsular repair details, triggering post-payment audit or prepayment review.
• Modifier 22 unsupported — appended without operative note language quantifying increased intensity, time, or technical difficulty beyond the standard vignette.
• Prior authorization missing or not obtained for the 29806 + 29807 combination, which many payers require separately from single-code auth.