Arthroscopic surgical repair of the rotator cuff, performed entirely through the shoulder joint via endoscopic technique.

Verified May 8, 2026 · 7 sources ↓

Medicare: $976.31
Total RVUs: 29.23
Global, days: 90
Region: Shoulder

Drawn from CMSAAOSHCITViaante: OrthopedicKZA

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Confirm full or partial tear with specific tendon(s) identified (supraspinatus, infraspinatus, subscapularis, teres minor)
Document tear size in centimeters and classification (partial vs. full thickness, retraction grade)
Describe repair technique — suture anchor configuration, number of anchors, single vs. double row
State that the procedure was performed entirely arthroscopically (no open or mini-open component)
Record the surgical approach and portal placement used during the procedure — avoid generic 'standard approach' language
Include pre-op imaging (MRI or ultrasound) correlating with intraoperative findings
If 29823 is billed separately, document that extensive debridement occurred in a different compartment or area of the shoulder than the repair site
If 29826 is billed, document clinical necessity of subacromial decompression distinct from the repair indication

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 58 Staged or related 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

Related ICD-10 diagnoses

Diagnoses commonly reported with CPT 29827.

Source · CMS LCDs · AAOS specialty guidance · claims-pattern analysis

M75.110 M75.120 M75.100 S46.011A

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 29827 covers arthroscopic rotator cuff repair — a fully endoscopic procedure addressing full- or partial-thickness tears of the rotator cuff tendons. The 90-day global period bundles the preoperative visit on the day before surgery, the procedure itself, and all routine postoperative care through day 90. Anything unrelated to the shoulder repair billed within that window requires modifier 24 or 25.

Diagnostic arthroscopy (29805) is bundled into 29827 when a surgical procedure follows. Never bill both at the same encounter. Add-on code 29826 (subacromial decompression) is separately reportable with 29827 per CPT parenthetical instructions and AAOS GSD guidance, but payers following AIM medical necessity guidelines may deny 29826 as not medically necessary — document the clinical rationale explicitly. Extensive debridement (29823) is also generally bundled into 29827 under NCCI rules unless performed in a distinctly different area of the same shoulder, in which case it may be separately reported. Lysis of adhesions (29825) is bundled into 29827 for Medicare Part B with no modifier override permitted; private payers following CPT rules may allow both.

For open or mini-open rotator cuff repair, use 23412 instead. If distal clavicle resection (29824) is performed at the same session, report it with modifier 51. Laterality modifiers LT and RT are required by most payers.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	15.2
Practice expense RVU	10.98
Malpractice RVU	3.05
Total RVU	29.23
Medicare national rate	$976.31
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	$976.31
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 29827 get rejected.

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

Diagnostic arthroscopy 29805 billed alongside 29827 — 29805 is bundled when a surgical procedure is performed at the same encounter
29826 denied as not medically necessary by payers using AIM guidelines, even when CPT parentheticals permit it with 29827
29823 bundled into 29827 when documentation fails to show debridement occurred in a different area of the shoulder
Missing laterality modifier (LT or RT) causing rejection or pended claim
Open rotator cuff repair coded as 29827 — arthroscopic technique must be confirmed in the operative note; open repair maps to 23412
Post-op visits billed without modifier 24 during the 90-day global period, triggering automatic denial

Frequently asked questions

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

01Can I bill 29805 and 29827 together when the surgeon started with a diagnostic look before proceeding to repair?

No. When a surgical procedure is performed, the diagnostic arthroscopy is bundled into it. Report only 29827. This is an NCCI rule, not just a payer policy.

02Is 29826 separately billable with 29827?

Per CPT parenthetical instructions and AAOS GSD, yes — 29826 is an add-on code listed in conjunction with 29827. However, payers using AIM medical necessity guidelines are actively denying 29826 on the grounds that subacromial decompression is not medically necessary. AAOS, ASES, AANA, and AOSSM have challenged these guidelines. Appeal with the CPT parenthetical, the absence of an NCCI edit, and specific clinical documentation.

03Can 29823 be billed separately with 29827?

Only if the extensive debridement was performed in a distinctly different area of the same shoulder than the rotator cuff repair. NCCI policy bundles 29823 into 29827 by default; separate reporting requires documentation placing the debridement in a different compartment.

04What modifier applies if the same shoulder requires a return to the OR during the 90-day global for an unplanned complication related to the original repair?

Use modifier 78. It signals an unplanned return to the OR for a procedure related to the original surgery within the global period. Do not use modifier 79, which is for unrelated procedures.

05Can 29825 (lysis of adhesions) and 29827 be billed together?

For Medicare Part B: no. An NCCI edit bundles 29825 into 29827, and CMS does not permit modifier override on this pair. For private payers following CPT rules, the combination is separately reportable when supported by distinct diagnoses and medical necessity documentation.

06When should I use 23412 instead of 29827?

Use 23412 when the operative note documents an open or mini-open rotator cuff repair. CPT 29827 is strictly for fully arthroscopic technique. If the surgeon converted to open, 29827 is wrong regardless of how the case started.

07Does modifier 51 apply when 29824 is performed at the same session as 29827?

Yes. CPT instructs that when arthroscopic distal clavicle resection (29824) is performed at the same setting as 29827, report 29824 with modifier 51. Append LT or RT for laterality as required by the payer.

Sources & references

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

01CMS Physician Fee Schedule 2026
02CMS NCCI Policy Manual 2024, Chapter 4 — https://www.cms.gov/files/document/medicare-ncci-policy-manual-2024-chapter-4.pdf
03AAOS GSD 2020 CPT Code 29827 — https://www.aaos.org/globalassets/quality-and-practice-resources/coding-and-reimbursement/appeals-resources/shoulder/gsd_2020-29827.pdf
04AAOS Resources for Appeals of Shoulder Arthroscopy Denials — https://www.aaos.org/quality/coding-and-reimbursement/resources-to-support-coding-appeals/shoulder-arthroscopy-appeals/
05HCIThreads: Shoulder to Shoulder CPT Arthroscopic Coding — https://healthcareinspiredllc.com/shoulder-to-shoulder-cpt-arthroscopic-diagnostic-and-surgical-procedure-coding/
06Viaante: Orthopedic Shoulder Surgery Coding Errors to Avoid in 2026 — https://www.viaante.com/resource-center/blogs/top-orthopedic-shoulder-surgery-coding-errors-to-avoid-in-2026-boost-accuracy-and-reduce-denials/
07KZA Coding Coaches: Lysis of Adhesions in the Shoulder — https://www.kzanow.com/coding-coaches/lysis-of-adhesions-in-the-shoulder

Mira AI Scribe

Mira's AI scribe captures tear size and location, specific tendon(s) involved, repair technique (anchor count, row configuration), and confirmation of fully arthroscopic approach from the surgeon's dictation. This prevents the most common audit flag — operative notes that reference a rotator cuff repair without specifying whether the approach was open, mini-open, or fully endoscopic — which can cause downcoding to 23412 or outright denial of 29827.

See how Mira captures CPT 29827 documentation