CPT code 23066: Shoulder biopsy, deep tissue2026 Medicare rate & RVUs in Minnesota
Report this code for operative biopsy sampling of deep soft tissue in the shoulder area when tissue is obtained for diagnostic evaluation.
In Minnesota, Medicare pays $617.16 for 23066 in the office and $350.45 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 23066 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 23066 covers
This code represents operative sampling of deep soft tissue in the shoulder area for diagnostic evaluation, such as assessment of an indeterminate mass or other abnormal tissue. An orthopedic surgeon or other surgeon exposes the target tissue and removes a specimen for examination. It is distinct from a superficial shoulder-tissue biopsy and from an operation that removes the entire lesion. The service is generally performed in an operating room or other surgical setting.
Select the code based on the documented depth and the fact that tissue was sampled rather than the full lesion excised. The operative report should identify the shoulder site, the deep tissue sampled, and the biopsy performed. This major surgery has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery; 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.
How Minnesota compares for 23066
Across 109 of 109 payment localities, the office rate for 23066 runs from $546.55 in Arkansas to $827.81 in San Benito County, CA. Minnesota pays $617.16. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Minnesota · this page$617.16
- Los Angeles, CA · California$704.26+$87.10
- Washington, DC area · District of Columbia$717.60+$100.44
- Miami, FL · Florida$691.23+$74.07
- Chicago, IL · Illinois$668.65+$51.49
- Manhattan, NY · New York$726.26+$109.10
- Alaska · Alaska$711.35+$94.19
Other areas in Minnesota first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $555.40 | $328.61 |
| ArkansasArkansas | $546.55 | $323.91 |
| ArizonaArizona | $607.07 | $355.92 |
| Bakersfield, CACalifornia | $659.92 | $375.84 |
| Chico, CACalifornia | $657.39 | $373.32 |
| El Centro, CACalifornia | $657.55 | $373.47 |
| Fresno, CACalifornia | $657.39 | $373.32 |
| Hanford, CACalifornia | $657.39 | $373.32 |
| Madera, CACalifornia | $657.39 | $373.32 |
| Merced, CACalifornia | $657.39 | $373.32 |
| Modesto, CACalifornia | $657.39 | $373.32 |
| Napa, CACalifornia | $763.96 | $422.35 |
| Oxnard, CACalifornia | $700.73 | $394.36 |
| Redding, CACalifornia | $657.39 | $373.32 |
| Rest of CaliforniaCalifornia | $657.39 | $373.32 |
| Riverside, CACalifornia | $667.27 | $383.20 |
| Sacramento, CACalifornia | $690.53 | $389.09 |
| Salinas, CACalifornia | $688.01 | $387.61 |
| San Diego, CACalifornia | $704.89 | $394.90 |
| Marin County, CACalifornia | $808.79 | $443.33 |
| San Francisco, CACalifornia | $807.74 | $442.28 |
| San Benito County, CACalifornia | $827.81 | $454.06 |
| Santa Clara County, CACalifornia | $823.54 | $449.79 |
| San Luis Obispo, CACalifornia | $676.95 | $381.74 |
| Santa Cruz, CACalifornia | $712.09 | $397.17 |
| Santa Maria, CACalifornia | $690.78 | $388.56 |
| Santa Rosa, CACalifornia | $719.26 | $400.97 |
| Stockton, CACalifornia | $657.39 | $373.32 |
| Vallejo, CACalifornia | $762.46 | $420.84 |
| Visalia, CACalifornia | $657.39 | $373.32 |
| Yuba City, CACalifornia | $657.39 | $373.32 |
| ColoradoColorado | $649.66 | $373.88 |
| ConnecticutConnecticut | $669.88 | $390.73 |
| DelawareDelaware | $617.74 | $361.66 |
| Fort Lauderdale, FLFlorida | $656.34 | $393.78 |
| Rest of FloridaFlorida | $621.04 | $373.25 |
| Atlanta, GAGeorgia | $639.47 | $376.14 |
| Rest of GeorgiaGeorgia | $582.37 | $351.17 |
| Hawaii, Guam, HIHawaii | $674.99 | $380.29 |
| IowaIowa | $568.40 | $331.24 |
| IdahoIdaho | $573.01 | $334.56 |
| East St. Louis, ILIllinois | $620.36 | $381.91 |
| Rest of IllinoisIllinois | $603.32 | $366.68 |
| Suburban Chicago, ILIllinois | $662.58 | $396.39 |
| IndianaIndiana | $576.60 | $336.33 |
| KansasKansas | $566.69 | $332.38 |
| KentuckyKentucky | $572.49 | $342.07 |
| New Orleans, LALouisiana | $602.94 | $359.04 |
| Rest of LouisianaLouisiana | $571.99 | $342.61 |
| Metropolitan Boston, MAMassachusetts | $716.21 | $406.74 |
| Rest of MassachusettsMassachusetts | $645.71 | $372.78 |
| Baltimore area, MDMaryland | $668.33 | $390.22 |
| Rest of MarylandMaryland | $629.94 | $367.64 |
| Rest of MaineMaine | $577.59 | $339.13 |
| Southern Maine, MEMaine | $610.17 | $353.31 |
| Detroit, MIMichigan | $630.76 | $380.64 |
| Rest of MichiganMichigan | $589.98 | $353.34 |
| Metropolitan Kansas City, MOMissouri | $597.14 | $353.76 |
| Metropolitan St. Louis, MOMissouri | $603.82 | $357.07 |
| Rest of MissouriMissouri | $562.02 | $338.60 |
| MississippiMississippi | $554.34 | $331.18 |
| MontanaMontana | $625.54 | $366.35 |
| North CarolinaNorth Carolina | $584.03 | $342.20 |
| North DakotaNorth Dakota | $607.35 | $348.15 |
| NebraskaNebraska | $571.46 | $332.22 |
| New HampshireNew Hampshire | $640.41 | $370.59 |
| Northern New JerseyNew Jersey | $709.29 | $408.63 |
| Rest of New JerseyNew Jersey | $676.03 | $392.99 |
| New MexicoNew Mexico | $594.02 | $356.34 |
| NevadaNevada | $620.92 | $361.47 |
| NYC suburbs and Long Island, NYNew York | $746.87 | $438.69 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $681.57 | $397.75 |
| Queens, NYNew York | $730.93 | $424.57 |
| Rest of New YorkNew York | $593.73 | $347.49 |
| OhioOhio | $586.27 | $349.63 |
| OklahomaOklahoma | $570.07 | $338.61 |
| Portland, OROregon | $670.47 | $382.51 |
| Rest of OregonOregon | $614.65 | $356.50 |
| Metropolitan Philadelphia, PAPennsylvania | $652.70 | $382.88 |
| Rest of PennsylvaniaPennsylvania | $586.61 | $348.67 |
| Puerto RicoPuerto Rico | $630.14 | $368.10 |
| Rhode IslandRhode Island | $639.95 | $372.21 |
| South CarolinaSouth Carolina | $586.42 | $346.92 |
| South DakotaSouth Dakota | $605.19 | $346.00 |
| TennesseeTennessee | $569.97 | $334.37 |
| Austin, TXTexas | $648.76 | $374.54 |
| Beaumont, TXTexas | $582.47 | $346.61 |
| Brazoria, TXTexas | $615.86 | $359.01 |
| Dallas, TXTexas | $620.68 | $362.52 |
| Fort Worth, TXTexas | $616.53 | $360.96 |
| Galveston, TXTexas | $618.25 | $360.87 |
| Houston, TXTexas | $635.09 | $377.71 |
| Rest of TexasTexas | $599.42 | $353.44 |
| UtahUtah | $595.17 | $351.53 |
| VirginiaVirginia | $608.83 | $354.05 |
| Virgin Islands, VIUnited States Virgin Islands | $630.14 | $368.10 |
| VermontVermont | $605.87 | $349.27 |
| Rest of WashingtonWashington | $644.18 | $371.26 |
| King County, WAWashington | $730.24 | $412.21 |
| WisconsinWisconsin | $585.23 | $336.92 |
| West VirginiaWest Virginia | $579.25 | $354.01 |
| WyomingWyoming | $617.61 | $358.42 |
23066 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$546.55
$742.60
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $711.35 | 1 |
| AL | $555.40 | 1 |
| AR | $546.55 | 1 |
| AZ | $607.07 | 1 |
| CA | $657.39–$827.81 | 29 |
| CO | $649.66 | 1 |
| CT | $669.88 | 1 |
| DC | $717.60 | 1 |
| DE | $617.74 | 1 |
| FL | $621.04–$691.23 | 3 |
| GA | $582.37–$639.47 | 2 |
| GU | $674.99 | 1 |
| HI | $674.99 | 1 |
| IA | $568.40 | 1 |
| ID | $573.01 | 1 |
| IL | $603.32–$668.65 | 4 |
| IN | $576.60 | 1 |
| KS | $566.69 | 1 |
| KY | $572.49 | 1 |
| LA | $571.99–$602.94 | 2 |
| MA | $645.71–$716.21 | 2 |
| MD | $629.94–$717.60 | 3 |
| ME | $577.59–$610.17 | 2 |
| MI | $589.98–$630.76 | 2 |
| MN | $617.16 | 1 |
| MO | $562.02–$603.82 | 3 |
| MS | $554.34 | 1 |
| MT | $625.54 | 1 |
| NC | $584.03 | 1 |
| ND | $607.35 | 1 |
| NE | $571.46 | 1 |
| NH | $640.41 | 1 |
| NJ | $676.03–$709.29 | 2 |
| NM | $594.02 | 1 |
| NV | $620.92 | 1 |
| NY | $593.73–$746.87 | 5 |
| OH | $586.27 | 1 |
| OK | $570.07 | 1 |
| OR | $614.65–$670.47 | 2 |
| PA | $586.61–$652.70 | 2 |
| PR | $630.14 | 1 |
| RI | $639.95 | 1 |
| SC | $586.42 | 1 |
| SD | $605.19 | 1 |
| TN | $569.97 | 1 |
| TX | $582.47–$648.76 | 8 |
| UT | $595.17 | 1 |
| VA | $608.83–$717.60 | 2 |
| VI | $630.14 | 1 |
| VT | $605.87 | 1 |
| WA | $644.18–$730.24 | 2 |
| WI | $585.23 | 1 |
| WV | $579.25 | 1 |
| WY | $617.61 | 1 |
How the 23066 rate is calculated
Each of 23066’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 · 23066
RVUs × geographic indexes × conversion factor
Work4.19
4.19 RVUs× 1.000 GPCI
Practice expense13.62
13.62 RVUs× 1.000 GPCI
Malpractice0.92
0.92 RVUs× 1.000 GPCI
Adjusted RVUs
18.7300
Conversion factor
$33.4009
Medicare rate
$625.60
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Minnesota inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
2,156
- Code
- 23066
- Physician work
- 4.19
- Practice expense
- 13.62
- Malpractice
- 0.92
GPCI2026.csv
66
- Locality
- Minnesota
- Physician work
- 1.000
- Practice expense
- 1.029
- Malpractice
- 0.296
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.19 | × 1.000 | 4.1900 |
| Practice expense | 13.62 | × 1.029 | 14.0150 |
| Malpractice | 0.92 | × 0.296 | 0.2723 |
| Total RVUs | 18.4773 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Minnesota$617.16
Office: (4.19 × 1 + 13.62 × 1.029 + 0.92 × 0.296) × $33.4009 = $617.16
Facility: (4.19 × 1 + 5.86 × 1.029 + 0.92 × 0.296) × $33.4009 = $350.45
Payment rules and modifiers for 23066
23066 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 23066
Shoulder biopsy, deep tissue
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 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) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 23066
Shoulder biopsy, deep tissue
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
23066 without 50 · national office
$625.60
Shoulder biopsy, deep tissue
23066-50 · Bilateral: 150%
$938.40
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).
How 23066 has changed in Minnesota
23066 · Office / nonfacility
$617.16
Effective 2026-10-01
The base rate is $64.84 higher than on 2025-10-01, moving from $552.32 to $617.16 (11.7%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$552.32changed to$617.16
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 4.30 changed to 4.19
- Practice expense RVU 12.20 changed to 13.62
- Malpractice RVU 0.90 changed to 0.92
- Practice expense GPCI 1.025 changed to 1.029
- Malpractice GPCI 0.300 changed to 0.296
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$566.10changed to$552.32
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 12.13 changed to 12.20
- Malpractice RVU 0.91 changed to 0.90
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$556.86changed to$566.10
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$565.79changed to$556.86
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 11.89 changed to 12.13
- Malpractice RVU 0.86 changed to 0.91
- Practice expense GPCI 1.019 changed to 1.025
- Malpractice GPCI 0.326 changed to 0.300
January 1, 2023
RVU23A
$571.59changed to$565.79
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 11.75 changed to 11.89
- Malpractice RVU 0.89 changed to 0.86
- Practice expense GPCI 1.013 changed to 1.019
- Malpractice GPCI 0.353 changed to 0.326
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$588.33changed to$571.59
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 12.10 changed to 11.75
- Malpractice RVU 0.86 changed to 0.89
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$571.30changed to$588.33
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 11.09 changed to 12.10
- Practice expense GPCI 1.012 changed to 1.013
- Malpractice GPCI 0.357 changed to 0.353
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$566.77changed to$571.30
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 10.98 changed to 11.09
- Malpractice RVU 0.90 changed to 0.86
- Practice expense GPCI 1.011 changed to 1.012
- Malpractice GPCI 0.362 changed to 0.357
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$560.43changed to$566.77
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 10.83 changed to 10.98
- Malpractice RVU 0.88 changed to 0.90
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$556.46changed to$560.43
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 10.73 changed to 10.83
- Malpractice RVU 0.89 changed to 0.88
- Practice expense GPCI 1.016 changed to 1.011
- Malpractice GPCI 0.341 changed to 0.362
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$553.91changed to$556.46
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 10.67 changed to 10.73
- Malpractice RVU 0.90 changed to 0.89
- Practice expense GPCI 1.020 changed to 1.016
- Malpractice GPCI 0.319 changed to 0.341
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$556.87changed to$553.91
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 10.69 changed to 10.67
- Malpractice RVU 0.92 changed to 0.90
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$554.10changed to$556.87
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$546.28changed to$554.10
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 10.54 changed to 10.69
- Malpractice RVU 0.80 changed to 0.92
- Practice expense GPCI 1.016 changed to 1.020
- Malpractice GPCI 0.301 changed to 0.319
Held through RVU15B.
January 1, 2014
RVU14A
$551.01changed to$546.28
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 11.52 changed to 10.54
- Malpractice RVU 0.84 changed to 0.80
- Practice expense GPCI 1.012 changed to 1.016
- Malpractice GPCI 0.282 changed to 0.301
Held through RVU14B, RVU14C, RVU14D.
October 1, 2013
RVU13D
No ratechanged to$551.01
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $617.16 | $350.45 | RVU26D |
| 2026-07-01 | $617.16 | $350.45 | RVU26C |
| 2026-04-01 | $617.16 | $350.45 | RVU26B |
| 2026-01-01 | $617.16 | $350.45 | RVU26A |
| 2025-10-01 | $552.32 | $355.37 | RVU25D |
| 2025-07-01 | $552.32 | $355.37 | RVU25C |
| 2025-04-01 | $552.32 | $355.37 | RVU25B |
| 2025-01-01 | $552.32 | $355.37 | RVU25A |
| 2024-10-01 | $566.10 | $359.33 | RVU24D |
| 2024-07-01 | $566.10 | $359.33 | RVU24C |
| 2024-04-01 | $566.10 | $359.33 | RVU24B |
| 2024-03-09 | $566.10 | $359.33 | RVU24AR |
| 2024-01-01 | $556.86 | $353.47 | RVU24A |
| 2023-10-01 | $565.79 | $358.26 | RVU23D |
| 2023-07-01 | $565.79 | $358.26 | RVU23C |
| 2023-04-01 | $565.79 | $358.26 | RVU23B |
| 2023-01-01 | $565.79 | $358.26 | RVU23A |
| 2022-10-01 | $571.59 | $358.10 | RVU22D |
| 2022-07-01 | $571.59 | $358.10 | RVU22C |
| 2022-04-01 | $571.59 | $358.10 | RVU22B |
| 2022-01-01 | $571.59 | $358.10 | RVU22A |
| 2021-10-01 | $588.33 | $360.70 | RVU21D |
| 2021-07-01 | $588.33 | $360.70 | RVU21C |
| 2021-04-01 | $588.33 | $360.70 | RVU21B |
| 2021-01-01 | $588.33 | $360.70 | RVU21A |
| 2020-10-01 | $571.30 | $357.64 | RVU20D |
| 2020-07-01 | $571.30 | $357.64 | RVU20C |
| 2020-04-01 | $571.30 | $357.64 | RVU20B |
| 2020-01-01 | $571.30 | $357.64 | RVU20A |
| 2019-10-01 | $566.77 | $356.17 | RVU19D |
| 2019-07-01 | $566.77 | $356.17 | RVU19C |
| 2019-04-01 | $566.77 | $356.17 | RVU19B |
| 2019-01-01 | $566.77 | $356.17 | RVU19A |
| 2018-10-01 | $560.43 | $352.25 | RVU18D |
| 2018-07-01 | $560.43 | $352.25 | RVU18C |
| 2018-04-01 | $560.43 | $352.25 | RVU18B |
| 2018-01-01 | $560.43 | $352.25 | RVU18AR1 |
| 2017-10-01 | $556.46 | $350.08 | RVU17D |
| 2017-07-01 | $556.46 | $350.08 | RVU17C |
| 2017-04-01 | $556.46 | $350.08 | RVU17B |
| 2017-01-01 | $556.46 | $350.08 | RVU17A |
| 2016-10-01 | $553.91 | $348.30 | RVU16D |
| 2016-07-01 | $553.91 | $348.30 | RVU16C |
| 2016-04-01 | $553.91 | $348.30 | RVU16B |
| 2016-01-01 | $553.91 | $348.30 | RVU16A |
| 2015-10-01 | $556.87 | $349.42 | RVU15D |
| 2015-07-01 | $556.87 | $349.42 | RVU15C |
| 2015-04-01 | $554.10 | $347.68 | RVU15B |
| 2015-01-01 | $554.10 | $347.68 | RVU15A |
| 2014-10-01 | $546.28 | $344.64 | RVU14D |
| 2014-07-01 | $546.28 | $344.64 | RVU14C |
| 2014-04-01 | $546.28 | $344.64 | RVU14B |
| 2014-01-01 | $546.28 | $344.64 | RVU14A |
| 2013-10-01 | $551.01 | $339.94 | RVU13D |
| 2013-07-01 | Rate data unavailable | Rate data unavailable | RVU13C |
| 2013-04-01 | Rate data unavailable | Rate data unavailable | RVU13B |
| 2013-01-01 | Rate data unavailable | Rate data unavailable | RVU13AR |
Where the Minnesota rate applies
Minnesota is a Medicare payment area, not a city. Our Census mapping connects it to 916 cities and communities in Minnesota. Some span more than one payment area; confirm with the service ZIP.
- Ada
- Adams
- Adrian
- Afton
- Aitkin
- Akeley
- Albany
- Albert Lea
23066 billing questions
How does this differ from 23065?
23066 is for biopsy of deep shoulder-area tissue; 23065 is the superficial-tissue sibling. The operative documentation should support the depth selected.
When should an excision code be considered instead?
Use an applicable shoulder-lesion excision code when the operation removes the lesion rather than taking a diagnostic sample. Deep excision codes are selected in part by lesion size.
Is the pathologist's examination included?
This code represents the surgeon's operative tissue sampling. A pathologist's examination is a distinct service when performed and appropriately reported.
What is included in the global period?
The 90-day global includes the related preoperative visit on the day before surgery and related postoperative care for 90 days.
How are bilateral biopsies and other same-session procedures handled?
Bilateral reporting with modifier 50 is paid at 150%. For multiple procedures in one session, the highest-valued procedure is paid in full and the others at 50%.
Can an assistant or co-surgeon be reported?
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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