Billing code 23921: Amputation closureMedicare rate & RVUs in Guam
Reports delayed surgical closure of an open shoulder-disarticulation wound when the stump is closed in a separate operative session.
CMS doesn’t publish an office rate for 23921 in Guam.
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 9 sections
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.
23921 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $474.28 |
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
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share 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.
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).
23921 compared with similar codes
Compare codes
23921 vs 23920 vs 23900 vs 13160: national Medicare rates
Swap in your local Medicare rate.
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.
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
Fee sheets
Put 23921 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →