Glossary · Clinical

Rotator cuff repair

Rotator cuff repair is a surgical procedure that restores one or more torn tendons of the rotator cuff—supraspinatus, infraspinatus, subscapularis, or teres minor—to their anatomic footprint on the humeral head. It is performed either arthroscopically (CPT 29827) or via open technique (CPT 23410 for acute, 23412 for chronic, 23420 for complete avulsion reconstruction).

Verified May 8, 2026 · 7 sources ↓

Drawn from CMSAAPCZimmerbiometProvidencehealthplanInfinx

Definition

Source · Editorial summary grounded in 7 cited references ↓

The rotator cuff is a confluence of four musculotendinous units that stabilize the glenohumeral joint and drive shoulder rotation and abduction. When one or more tendons tear—whether acutely from trauma or progressively from chronic degeneration—surgical repair reattaches the tendon(s) to the greater or lesser tuberosity using suture anchors, transosseous tunnels, or equivalent fixation constructs.

Approach determines code selection. Arthroscopic repair (CPT 29827) covers repair of one, two, or three tendons regardless of the number of portals created; an additional portal for subscapularis access is an inclusive component, not a separately billable service. Open acute repair (CPT 23410) and open chronic repair (CPT 23412) apply when the surgeon does not use an arthroscope or converts fully to open. CPT 23420 is reserved for reconstruction—not simple repair—of a complete rotator cuff avulsion that is chronic in nature and typically involves acromioplasty; a three-tendon repair alone does not automatically qualify. If a procedure begins arthroscopically but is completed open, only the open code is reported.

On the hospital side, inpatient encounters use ICD-10-PCS codes under the Medical and Surgical / Tendon section, with body-part values distinguishing right (1) versus left (2) shoulder tendons and approach values distinguishing open (0) versus percutaneous endoscopic (4). For outpatient and ASC settings, CPT 23410, 23412, and 29827 all map to APC 5114 (Level 4 Musculoskeletal Procedures) under OPPS status indicator J1, meaning most co-submitted Part B services are packaged with the primary procedure.

Why it matters

Rotator cuff repair claims are among the most frequently audited orthopedic procedures. Payers scrutinize tear size, chronicity, tendon count, and approach, and a single misclassification—billing 23410 (acute) when the operative note documents a chronic degenerative tear, or reporting 29827 alongside CPT 29805 (diagnostic arthroscopy) in the same session—triggers automatic denial or NCCI edit rejection. Orthopedic practices routinely forfeit 15% or more of shoulder-procedure revenue through bundling errors, missing laterality modifiers, and under-coded or over-coded approach designations. Accurate code selection also determines the appropriate medical-necessity ICD-10 linkage, which affects prior-authorization approval and appeal outcomes.

Common mistakes

Where people most often go wrong with this concept.

Source · Editorial brief grounded in cited references ↓

Billing CPT 29805 (diagnostic arthroscopy) alongside CPT 29827 in the same encounter—the diagnostic component is bundled into the surgical code per CMS NCCI policy.
Selecting CPT 23410 (acute open repair) when the operative report and clinical history support a chronic degenerative tear, which requires CPT 23412.
Using CPT 23420 for a multi-tendon repair when the procedure is a repair, not a reconstruction; 23420 requires a complete avulsion with acromioplasty and reconstruction-level work.
Billing CPT 29823 (extensive debridement) separately with CPT 29827 when the debridement is performed in the same area as the repair or involves tissue debrided as part of the repair itself—only separately reportable when performed in a distinct shoulder area per NCCI Chapter 4.
Counting additional portals—including a subscapularis portal—as separate procedures; CPT 29827 covers all tendon repairs regardless of portal count.
Omitting laterality modifiers RT or LT on CPT 29827 claims, a leading cause of payer rejection.
Billing CPT 29827 and CPT 29806 (capsulorrhaphy) without confirming each meets its individual medical-necessity threshold; conflating the two codes because both involve shoulder arthroscopy.
Applying modifier 59 to CPT 29805 when it is performed at the same site and same session as CPT 29827—modifier 59 does not override the NCCI bundling rule here.

Related codes

Codes commonly involved when this concept appears in practice.

CPT

Modifiers

RT Right side LT Left side 59 Distinct procedural service 51 Multiple procedures 57 Decision for surgery 26 Professional component

Frequently asked questions

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

01Can CPT 29827 be billed for two or three tendon repairs, or is a separate code required for each tendon?

CPT 29827 covers repair of one, two, or three rotator cuff tendons performed arthroscopically in a single session. No additional units or separate codes are reported for additional tendons; the code is reported once regardless of tendon count.

02What is the correct code when a surgeon starts arthroscopically but completes the rotator cuff repair through an open incision?

When a procedure converts from arthroscopic to open, only the open approach code is reported—CPT 23410 (acute) or 23412 (chronic). Billing both the arthroscopic and open codes for the same repair is not permitted.

03Is extensive debridement (CPT 29823) ever separately reportable with CPT 29827?

Yes, but only under specific conditions. Per CMS NCCI Chapter 4 (2025), CPT 29823 may be reported separately with CPT 29827 if the extensive debridement is performed in a distinctly different area of the same shoulder. If the debridement involves tissue that is being prepared for the repair itself, it is not separately reportable.

04When does CPT 23420 apply instead of 23412 for a chronic rotator cuff tear?

CPT 23420 is reserved for reconstruction of a complete rotator cuff avulsion—a higher-complexity intervention than a standard repair—and the procedure description includes acromioplasty. Repairing multiple tendons through a chronic open approach alone does not justify 23420; the operative report must support a full reconstruction with the complexity that distinguishes it from routine repair.

05Are laterality modifiers required on rotator cuff repair CPT codes?

Yes. Modifiers RT (right) and LT (left) are required on rotator cuff repair codes including CPT 29827, 23410, 23412, and 23420. Missing laterality is a leading cause of claim rejection by CMS and commercial payers.

06Can CPT 29827 and CPT 29828 (biceps tenodesis) be billed together?

Yes. Because arthroscopic rotator cuff repair and biceps tenodesis are distinct procedures addressing separate structures, CPT 29827 and CPT 29828 may be reported together when both are performed. Modifier 51 may apply to the secondary procedure depending on payer rules.

07Are there specific ICD-10 LCDs or NCDs that govern medical necessity for rotator cuff repair codes?

As of current CMS guidance, there are no National Coverage Determinations or Local Coverage Determinations that publish an approved ICD-10 list specifically for CPT 23410, 23412, 23420, or 29827. Coders must link the most accurate ICD-10 diagnosis code—documenting tear type, acuity, and laterality—to support medical necessity on a case-by-case basis.

Sources & references

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

Mira AI Scribe

Mira flags the following decision points at documentation and claim-prep time for rotator cuff repair: **Approach & chronicity:** Mira prompts the scribe to capture whether the repair was fully arthroscopic, fully open, or converted from arthroscopic to open. If the op note contains language indicating a chronic, degenerative tear, Mira surfaces CPT 23412 rather than 23410 and alerts the coder if 23410 was pre-selected. Conversion to open cases auto-suppress the arthroscopic code. **Tendon count & portal note:** Because CPT 29827 covers one-to-three tendons in a single code, Mira records each tendon repaired for audit defense without splitting to multiple codes. Subscapularis portal documentation is flagged as an inclusive component to prevent erroneous unbundling. **Bundling checks:** Mira cross-references CPT 29805 against 29827 and blocks simultaneous billing in the same encounter. It also evaluates whether debridement (29822/29823) qualifies for separate reporting under the NCCI three-exception rule (distinct area + one of: 29824, 29827, 29828). **Laterality:** Mira auto-appends RT or LT based on the laterality documented in the operative note header and flags any claim line for 29827, 23410, 23412, or 23420 that is missing a side modifier. **Modifier logic:** Modifier 57 is surfaced when a same-day or day-prior E/M led to the surgical decision. Modifier 51 is suggested when a clearly distinct co-procedure (e.g., biceps tenodesis, 29828) is performed and separately reportable. Modifier 59 is restricted to scenarios meeting NCCI bypass criteria and is not auto-applied to 29805 in the same session as 29827.

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Related terms

SLAP repair Clinical

SLAP repair is an arthroscopic surgical procedure that reattaches or debrides a torn superior labrum (anterior to posterior) in the shoulder joint. It is billed exclusively with CPT 29807, which is reserved for confirmed SLAP lesions only—not generic labral tears.