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Billing code 23405: Shoulder tenotomyMedicare rate & RVUs

Reports surgical division of one tendon in the shoulder area, such as a tendon release performed to address shoulder pain or restricted movement.

CMS RVU26DEffective Oct 1, 2026109 payment localities3.6K Medicare services in 2024

Medicare pays $574.50 for 23405 nationally in a facility.

Medicare rate · 23405

Shoulder tenotomy

Swap in your local Medicare rate.

Work RVUs
8.33
Total RVUs
17.20
Global days
090

National rate · 2026

$574.50

Facility setting, before claim adjustments.

See every locality for 23405 → · 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 23405 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 23405 covers

This procedure surgically divides one tendon in the shoulder area. An orthopedic surgeon or other qualified surgeon may perform it to release a tendon contributing to pain or restricted shoulder motion. A tenotomy may also be part of operative treatment for shoulder tendon disease, including treatment involving the long head of the biceps. The operative report should identify the tendon and describe the division performed.

Report this code when the procedure involves one tendon; the code for multiple tendons or muscles is a distinct choice. Documentation should support the shoulder location, the tendon treated, and the operative work. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; 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 23405 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

23405 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$521.36
Alaska*Unavailable$706.09
ArizonaUnavailable$559.42
ArkansasUnavailable$514.80
AtlantaUnavailable$589.71
AustinUnavailable$583.27
BakersfieldUnavailable$582.85
Baltimore/Surr. CntysUnavailable$609.12
BeaumontUnavailable$548.82
BrazoriaUnavailable$563.06

23405 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
23405 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 23405 rate is calculated

Each of 23405’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 · 23405

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 8.33Practice expense 7.31Malpractice 1.56

17.2000 adjusted RVUs×$33.4009 conversion factor=$574.50

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 23405

23405 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 23405

Shoulder tenotomy

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 · 23405

Shoulder tenotomy

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

23405 without 51 · national facility

$574.50

Shoulder tenotomy

23405-51 · Second procedure: 50%

$287.25

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

23405 compared with similar codes

Compare codes

23405 vs 23406 vs 23430 vs 23415 vs 23412: national Medicare rates

Swap in your local Medicare rate.

  • 23405
    Shoulder tenotomy · 8.33 wRVU
    —
  • 23406
    Tendon release · 10.73 wRVU
    —
  • 23430
    Biceps surgery · 9.92 wRVU
    —
  • 23415
    Shoulder decompression · 9 wRVU
    —
  • 23412
    Rotator cuff repair · 11.63 wRVU
    —

How to choose

23406Tendon release
Use 23405 for one tendon in the shoulder area; 23406 covers multiple tendons or muscles.
23430Biceps surgery
23405 represents tendon division. 23430 is used when the biceps tendon is repaired by tenodesis rather than simply divided.
23415Shoulder decompression
23415 addresses release of a shoulder ligament, not division of a tendon.
23412Rotator cuff repair
23412 describes repair of a chronic rotator cuff tear. It is not a substitute for reporting a distinct single-tendon division.

Codes related to 23405

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

Codes related to 23405
CodeHow it relatesNational office range
Same family
23406Tendon releaseShoulder-area tendon or muscle division involving multiple structures rather than a single tendon.No office rate
Used instead
23430Biceps surgeryBiceps tenodesis anchors the tendon rather than simply dividing it.No office rate
Often billed with
23412Rotator cuff repairChronic rotator cuff repair may accompany a separately documented shoulder tendon procedure.No office rate

23405 billing questions

When should I report this instead of 23406?

Report 23405 for division of a single tendon in the shoulder area. The multiple-tendon or muscle procedure is represented by 23406.

Can this code describe a biceps tenotomy?

It may describe surgical division of a single tendon in the shoulder area, including the long head of the biceps. The operative note should identify the tendon and the work performed.

Is modifier 50 appropriate for bilateral work?

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

What postoperative care is included?

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

How are multiple procedures in the same session paid?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is 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
RVUs for 23405PPRRVU2026_Oct_nonQPP.csv, line 2,196 (RVU26D)

Open CMS sourceHow we calculate rates

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