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CPT code 23420: Rotator cuff surgery, chronic complete avulsion2026 Medicare rate & RVUs

Reconstructs a chronic, complete rotator cuff avulsion when the extent of the tear calls for more than a routine cuff repair.

CMS RVU26DEffective Oct 1, 2026109 payment localities1.2K Medicare services in 2024

Medicare pays $906.50 for 23420 nationally in a facility.

Medicare rate · 23420

Rotator cuff surgery, chronic complete avulsion

Office or facility?

Work RVUs
13.2
Total RVUs
27.14
Global days
090

National rate · 2026

$906.50

Facility setting, before claim adjustments.

See every locality for 23420 →Billed by an NP, PA or therapist? →

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

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 23420 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 23420 covers

An orthopedic surgeon uses this service to reconstruct a chronic, complete rotator cuff avulsion, typically in an operative setting. The work addresses a longstanding, extensive cuff injury rather than an acute tear or a more limited chronic cuff repair. Acromioplasty is included, so it is part of the reported reconstruction rather than a separate service under this code.

Select the code when the operative report supports chronicity, complete avulsion, and reconstruction; document the tear and the repair performed. This major procedure has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is 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 23420 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

23420 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$819.71
AlaskaUnavailable$1,109.66
ArizonaUnavailable$881.61
ArkansasUnavailable$809.02
Atlanta, GAUnavailable$932.39
Austin, TXUnavailable$918.47
Bakersfield, CAUnavailable$914.52
Baltimore area, MDUnavailable$962.72
Beaumont, TXUnavailable$866.35
Brazoria, TXUnavailable$886.32

23420 rates by state

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

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
23420 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 23420 rate is calculated

Each of 23420’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 · 23420

RVUs × geographic indexes × conversion factor

Office or facility?

Work13.20

13.20 RVUs× 1.000 GPCI

Practice expense11.17

11.17 RVUs× 1.000 GPCI

Malpractice2.77

2.77 RVUs× 1.000 GPCI

Adjusted RVUs

27.1400

Conversion factor

$33.4009

Medicare rate

$906.50

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 23420

23420 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 23420

Rotator cuff surgery, chronic complete avulsion

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 23420

Rotator cuff surgery, chronic complete avulsion

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

23420 without 50 · national facility

$906.50

Rotator cuff surgery, chronic complete avulsion

23420-50 · Bilateral: 150%

$1,359.75

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).

When to use modifier 50

23420 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 23420

    Rotator cuff surgery, chronic complete avulsion13.2 wRVU

    Not priced

  • 23410

    Rotator cuff repair, acute tear, open11.11 wRVU

    Not priced

  • 23412

    Rotator cuff repair, chronic tear, open repair11.63 wRVU

    Not priced

  • 29827

    Rotator cuff repair, arthroscopic technique15.2 wRVU

    Not priced

How to choose

23410Rotator cuff repairAcute tear, open
23410 addresses acute rotator cuff repair. Choose 23420 for chronic, complete avulsion requiring reconstruction.
23412Rotator cuff repairChronic tear, open repair
23412 is for chronic cuff repair; 23420 represents reconstruction of a chronic, complete avulsion and includes acromioplasty.
29827Rotator cuff repairArthroscopic technique
29827 reports arthroscopic rotator cuff repair. Use 23420 when the documented service is the reconstruction represented by this code, not an arthroscopic repair.

Codes related to 23420

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

Codes related to 23420
CodeHow it relatesNational office range
Used instead
23410Rotator cuff repair, acute tear, openFor repair of an acute rotator cuff tear rather than chronic complete avulsion reconstruction.No office rate
23412Rotator cuff repair, chronic tear, open repairFor chronic cuff repair when the operative work does not require this reconstruction.No office rate
29827Rotator cuff repair, arthroscopic techniqueArthroscopic rotator cuff repair; distinguish by the operative approach and service performed.No office rate
Often billed with
23430Biceps surgery, open tendon fixationMay accompany the cuff reconstruction when a separately indicated biceps tendon procedure is performed.No office rate

23420 billing questions

When should this be chosen over 23412?

Use 23420 for a chronic, complete cuff avulsion requiring reconstruction. A chronic cuff repair without that reconstructive scope is more consistent with 23412.

Is acromioplasty separately reported?

Acromioplasty is included in 23420. Do not report it separately as work included in this reconstruction.

How is bilateral surgery reported?

For a bilateral procedure, report modifier 50; CMS pays the service at 150%.

Does the code include postoperative visits?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation, while team surgery is not permitted.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full; other procedures in the session are paid at 50% under the multiple procedure rule.

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
RVUs for 23420PPRRVU2026_Oct_nonQPP.csv, line 2,201 (RVU26D)

Open CMS sourceHow we calculate rates

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