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Billing code 23921: Amputation closureMedicare rate & RVUs

Reports delayed surgical closure of an open shoulder-disarticulation wound when the stump is closed in a separate operative session.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $459.26 for 23921 nationally in a facility.

Medicare rate · 23921

Amputation closure

Swap in your local Medicare rate.

Work RVUs
5.58
Total RVUs
13.75
Global days
090

National rate · 2026

$459.26

Facility setting, before claim adjustments.

See every locality for 23921 → · 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 23921 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 23921 covers

This service closes a shoulder-disarticulation wound that was left open and requires closure in a later operative session. The surgeon prepares the existing amputation wound and brings the tissue together to complete stump closure. It is distinct from performing the shoulder disarticulation itself. The procedure may arise after an amputation wound was intentionally left open or could not be closed at the initial operation; the operative report should establish that this is secondary closure of the shoulder-disarticulation site.

Report this code for the delayed closure, not for the initial disarticulation or routine wound care. The code has 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. For bilateral surgery, modifier 50 is paid at 150%. Assistant-at-surgery services are not paid; 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.

Where 23921 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

23921 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$412.77
Alaska*Unavailable$549.59
ArizonaUnavailable$446.27
ArkansasUnavailable$407.00
AtlantaUnavailable$471.60
AustinUnavailable$468.57
BakersfieldUnavailable$469.48
Baltimore/Surr. CntysUnavailable$488.74
BeaumontUnavailable$435.46
BrazoriaUnavailable$449.84

23921 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.

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23921 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 23921 rate is calculated

Each of 23921’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 · 23921

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 5.58Practice expense 6.97Malpractice 1.20

13.7500 adjusted RVUs×$33.4009 conversion factor=$459.26

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

Payment rules and modifiers for 23921

23921 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 23921

Amputation closure

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)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
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 · 23921

Amputation closure

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

23921 without 50 · national facility

$459.26

Amputation closure

23921-50 · Bilateral: 150%

$688.89

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

23921 compared with similar codes

Compare codes

23921 vs 23920 vs 23900 vs 13160: national Medicare rates

Swap in your local Medicare rate.

  • 23921
    Amputation closure · 5.58 wRVU
    —
  • 23920
    Shoulder amputation · 15.82 wRVU
    —
  • 23900
    Shoulder amputation · 20.2 wRVU
    —
  • 13160
    Wound closure · 11.74 wRVU
    —

How to choose

23920Shoulder amputation
Use 23920 for the shoulder disarticulation itself. Use 23921 when the open wound from that amputation is closed in a later operative session.
23900Shoulder amputation
23900 describes a more extensive amputation involving the shoulder girdle. It is not the delayed closure code for a shoulder-disarticulation stump.
13160Wound closure
13160 describes extensive or complicated secondary closure of a surgical wound or dehiscence. Use 23921 when the closure is specifically for a shoulder-disarticulation wound.

Codes related to 23921

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

Codes related to 23921
CodeHow it relatesNational office range
Same family
23920Shoulder amputationDescribes the shoulder disarticulation itself; this code describes delayed closure of its wound.No office rate
Used instead
23900Shoulder amputationDescribes a more extensive upper-limb amputation involving the shoulder girdle.No office rate
13160Wound closureDescribes extensive or complicated secondary wound closure when the shoulder-disarticulation-specific code does not apply.No office rate

23921 billing questions

How is this different from the shoulder disarticulation code?

This code is for closing the shoulder-disarticulation wound in a later operative session. The shoulder disarticulation code describes creating the amputation, not its delayed closure.

What documentation supports reporting this service?

The operative report should identify the prior shoulder disarticulation site, explain that the wound remained open, and describe the surgical steps used to close it.

Can routine postoperative wound care be reported separately?

Related postoperative care is included in the 90-day global period. This code describes the operative secondary closure, not routine care during recovery.

How are additional 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, with payment at 50%.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery services are not paid for this code. Co-surgeons and team surgery are not permitted.

How should bilateral closure be reported?

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

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 23921PPRRVU2026_Oct_nonQPP.csv, line 2,251 (RVU26D)

Open CMS sourceHow we calculate rates

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