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Billing code 23397: Muscle transferMedicare rate & RVUs

Reports multiple muscle transfers in the shoulder or upper arm, commonly performed to restore movement when paralysis or nerve injury has impaired function.

CMS RVU26DEffective Oct 1, 2026109 payment localities109 Medicare services in 2024

Medicare pays $1,042.78 for 23397 nationally in a facility.

Medicare rate · 23397

Muscle transfer

Work RVUs
16.34
Total RVUs
31.22
Global days
090

National rate · 2026

$1,042.78

Facility setting, before claim adjustments.

See every locality for 23397 →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.

On this page 10 sections
  1. Medicare rate
  2. What 23397 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 23397 covers

An orthopedic surgeon relocates multiple functioning muscles or muscle-tendon units in the shoulder or upper arm and attaches them to help restore a lost movement. These operations may be considered when paralysis or a nerve injury has left a muscle group unable to perform its usual function. The service is generally performed in a hospital or other surgical facility.

Select this code when the operative report supports multiple transfers in the shoulder or upper arm; a single transfer is distinguished by 23395. Document the donor structures, their new attachments, the operative site, and the functional goal. Medicare assigns 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 other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery services may be paid; co-surgeons require 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 23397 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

23397 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$944.73
Alaska*Unavailable$1,288.22
ArizonaUnavailable$1,014.23
ArkansasUnavailable$932.71
AtlantaUnavailable$1,073.87
AustinUnavailable$1,052.70
BakersfieldUnavailable$1,044.25
Baltimore/Surr. CntysUnavailable$1,106.85
BeaumontUnavailable$1,000.25
BrazoriaUnavailable$1,018.14

23397 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
23397 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 23397 rate is calculated

Each of 23397’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 · 23397

RVUs × geographic indexes × conversion factor

Work16.34

16.34 RVUs× 1.000 GPCI

Practice expense11.40

11.40 RVUs× 1.000 GPCI

Malpractice3.48

3.48 RVUs× 1.000 GPCI

Adjusted RVUs

31.2200

Conversion factor

$33.4009

Medicare rate

$1,042.78

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

Payment rules and modifiers for 23397

23397 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 23397

Muscle transfer

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)0The 150% bilateral adjustment doesn’t apply.
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 · 23397

Muscle transfer

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 51 · payment effect

With and without the modifier

23397 without 51 · national facility

$1,042.78

Muscle transfer

23397-51 · Second procedure: 50%

$521.39

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

23397 compared with similar codes

Compare codes · National

4 codes, side by side

  • 23397

    Muscle transfer16.34 wRVU

    Not priced

  • 23395

    Muscle transfer18.08 wRVU

    Not priced

  • 24301

    Tendon transfer10.12 wRVU

    Not priced

  • 25310

    Tendon transfer8.78 wRVU

    Not priced

How to choose

23395Muscle transfer
The distinction is the number of transfers: 23395 describes a single shoulder or upper-arm muscle transfer; 23397 is for multiple transfers.
24301Tendon transfer
Use 24301 for a muscle transfer at the upper arm or elbow site described by that code. 23397 is the shoulder or upper-arm multiple-transfer code.
25310Tendon transfer
25310 concerns tendon transfer at the wrist or forearm. 23397 concerns multiple muscle transfers in the shoulder or upper arm.

Codes related to 23397

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

Codes related to 23397
CodeHow it relatesNational office range
Same family
23395Muscle transferShoulder or upper-arm muscle transfer when the operation involves a single transfer.No office rate
Used instead
24301Tendon transferMuscle transfer directed to the upper arm or elbow rather than the shoulder or upper arm service described here.No office rate
25310Tendon transferTendon transfer for a wrist or forearm site, rather than shoulder or upper-arm muscle transfers.No office rate

23397 billing questions

How does 23397 differ from 23395?

23397 is for multiple muscle transfers in the shoulder or upper arm. Use 23395 when the operation involves a single transfer.

What documentation supports reporting multiple transfers?

The operative report should identify the transferred muscles or muscle-tendon units, their new attachments, the shoulder or upper-arm site, and the intended functional restoration.

Should modifier 50 be appended for bilateral work?

No. CMS identifies bilateral adjustment as inappropriate for this code.

How is postoperative care handled?

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 services may be paid. Co-surgeons are paid only when supporting documentation is provided; team surgery is not permitted.

What happens when another procedure is performed in the same session?

Under the standard multiple-procedure rule, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction.

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 23397PPRRVU2026_Oct_nonQPP.csv, line 2,194 (RVU26D)

Open CMS sourceHow we calculate rates

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