CPT code 23065: Shoulder biopsy, deep soft tissue2026 Medicare rate & RVUs

Medicare pays $231.47 for 23065 nationally in the office and $146.63 in a hospital or facility. Local office rates run $205.36–$298.35.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 23065 covers

This service involves surgically obtaining a tissue sample from deep soft tissue in the shoulder region, such as a deep soft-tissue mass. The surgeon makes an incision to reach the target and removes tissue for diagnostic examination; the procedure is a biopsy, not complete removal of a lesion. Orthopedic surgeons and other surgeons who evaluate shoulder-region masses may perform it in an outpatient operating room or hospital setting.

Select the code when the sampled structure is deep shoulder soft tissue. A record supporting the claim identifies the target and its location, documents the approach and tissue obtained, and distinguishes sampling from complete excision. The code has a 10-day global period, so related postoperative visits during that period are included. For bilateral procedures, modifier 50 is paid at 150%. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 23065 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

23065 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 23065 rate is calculated

Each of 23065’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 23065

23065 has a 10-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 50

23065 compared with similar codes

How to choose

23066Shoulder biopsyDeep tissue

Use 23065 for a deep soft-tissue target in the shoulder region; 23066 is for biopsy of bone in that region.

23071Shoulder mass excisionSubcutaneous, 3 cm or larger

This code describes deep soft-tissue sampling for diagnosis. Code 23071 is for complete excision of a subcutaneous shoulder lesion measuring 3 cm or more.

23073Shoulder tumor excisionDeep, 5 cm or larger

Use this code when deep shoulder soft tissue is sampled for diagnosis. Code 23073 describes complete excision of a deep shoulder tumor measuring 5 cm or more.

Codes related to 23065

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates