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Billing code 23920: Shoulder amputationMedicare rate & RVUs

Reports removal of an upper extremity through the shoulder joint, typically when trauma, tumor, or disease makes the limb unsalvageable.

CMS RVU26DEffective Oct 1, 2026109 payment localities22 Medicare services in 2024

Medicare pays $1,034.43 for 23920 nationally in a facility.

Medicare rate · 23920

Shoulder amputation

Swap in your local Medicare rate.

Work RVUs
15.82
Total RVUs
30.97
Global days
090

National rate · 2026

$1,034.43

Facility setting, before claim adjustments.

See every locality for 23920 → · 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 23920 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 23920 covers

This operation removes the arm at the shoulder joint. It may be performed for a severely damaged, nonviable limb or to treat a tumor or other disease that cannot be managed with a more distal amputation. Orthopedic, trauma, or musculoskeletal oncology surgeons typically perform it in an operating room. The level is the shoulder joint, rather than a forequarter amputation that also removes the scapula and part of the clavicle.

Report 23920 when the operative record supports disarticulation at the shoulder joint; document the indication, amputation level, and extent of removal. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and others at 50%. A bilateral procedure reported with modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; 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 23920 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

23920 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$936.49
Alaska*Unavailable$1,273.83
ArizonaUnavailable$1,006.06
ArkansasUnavailable$924.47
AtlantaUnavailable$1,064.87
AustinUnavailable$1,045.53
BakersfieldUnavailable$1,038.39
Baltimore/Surr. CntysUnavailable$1,098.23
BeaumontUnavailable$991.02
BrazoriaUnavailable$1,010.42

23920 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

View every state and territory as a table
23920 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 23920 rate is calculated

Each of 23920’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 · 23920

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 15.82Practice expense 11.79Malpractice 3.36

30.9700 adjusted RVUs×$33.4009 conversion factor=$1,034.43

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

Payment rules and modifiers for 23920

23920 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 23920

Shoulder amputation

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 · 23920

Shoulder amputation

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 50 · payment effect

With and without the modifier

23920 without 50 · national facility

$1,034.43

Shoulder amputation

23920-50 · Bilateral: 150%

$1,551.65

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

23920 compared with similar codes

Compare codes

23920 vs 23900 vs 23921 vs 23929: national Medicare rates

Swap in your local Medicare rate.

  • 23920
    Shoulder amputation · 15.82 wRVU
    —
  • 23900
    Shoulder amputation · 20.2 wRVU
    —
  • 23921
    Amputation closure · 5.58 wRVU
    —
  • 23929
    · 0 wRVU
    —

How to choose

23900Shoulder amputation
23920 removes the arm through the shoulder joint. 23900 describes the more extensive forequarter amputation involving shoulder-girdle structures.
23921Amputation closure
23920 reports the shoulder disarticulation; 23921 applies to secondary closure after that amputation.
23929Unlisted procedure shoulder
Use 23920 when the operation is a shoulder-joint disarticulation. 23929 is for a shoulder procedure without a more specific code.

Codes related to 23920

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

Codes related to 23920
CodeHow it relatesNational office range
Same family
23921Amputation closureDescribes secondary closure after shoulder disarticulation rather than the initial amputation.No office rate
Used instead
23900Shoulder amputationFor the more extensive forequarter amputation involving shoulder-girdle structures.No office rate
23929Unlisted procedure shoulderUnlisted shoulder procedure code when no specific code describes the operation performed.No office rate

23920 billing questions

How is 23920 distinguished from a forequarter amputation?

23920 describes removal through the shoulder joint. A forequarter amputation removes additional shoulder-girdle structures and is represented by 23900.

When is 23921 used instead?

23921 is for secondary closure after shoulder disarticulation, not the initial amputation. Use 23920 for the disarticulation itself.

What postoperative care is included?

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

How is a bilateral procedure reported?

CMS identifies this as a bilateral procedure; when reported with modifier 50, it is paid at 150%.

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.

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 23920PPRRVU2026_Oct_nonQPP.csv, line 2,250 (RVU26D)

Open CMS sourceHow we calculate rates

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