CPT code 23065: Shoulder biopsy, deep soft tissue2026 Medicare rate & RVUs in Maryland
Report this code for an open biopsy of deep soft tissue in the shoulder region when tissue is sampled for diagnosis rather than completely excised.
Medicare pays $233.00–$262.63 for 23065 in the office in Maryland, from Rest of Maryland to Washington, DC area. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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 in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$233.00 to $262.63
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | $246.02 | $154.99 |
| Rest of Maryland | $233.00 | $147.14 |
| Washington, DC area | $262.63 | $162.69 |
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.
How the rate is built · 23065
RVUs × geographic indexes × conversion factor
Work2.24
2.24 RVUs× 1.000 GPCI
Practice expense4.34
4.34 RVUs× 1.000 GPCI
Malpractice0.35
0.35 RVUs× 1.000 GPCI
Adjusted RVUs
6.9300
Conversion factor
$33.4009
Medicare rate
$231.47
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 23065
23065 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 23065
Shoulder biopsy, deep soft tissue
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 23065
Shoulder biopsy, deep soft tissue
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
23065 without 50 · national office
$231.47
Shoulder biopsy, deep soft tissue
23065-50 · Bilateral: 150%
$347.21
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
23065 compared with similar codes
Compare codes · National
4 codes, side by side
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.
23065 billing questions
How is this code distinguished from 23066?
This code is for a deep soft-tissue biopsy in the shoulder region. Use 23066 when the biopsy target is bone.
Should this code be used when the entire mass is removed?
No. It represents sampling for diagnosis, not complete lesion excision. For a complete excision, select the applicable shoulder excision code based on tissue depth and lesion size.
What documentation supports reporting this biopsy?
Document the shoulder-region target, that it is deep soft tissue, the biopsy approach, and the tissue sampled. The operative record should make clear that tissue was obtained for diagnosis rather than the lesion being completely excised.
Are related postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in this procedure's payment.
How does Medicare handle bilateral biopsies or another procedure in the same session?
A bilateral procedure reported with modifier 50 is paid at 150%. For multiple procedures in the same session, the highest-valued procedure is paid in full and the others are reduced to 50%.
Can an assistant or another surgeon be reported for this procedure?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
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
Show the CMS file lines behind this rate
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