No office rate
Use 23920 for the shoulder disarticulation itself. Use 23921 when the open wound from that amputation is closed in a later operative session.
On this page
CMS RVU26D · Effective 2026-10-01
23921 Amputation closure Medicare reimbursement rates in Indiana
Reports delayed surgical closure of an open shoulder-disarticulation wound when the stump is closed in a separate operative session. Compare 23921 office and facility rates across CMS payment localities in Indiana.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 23921 in Indiana?
Indiana has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$421.67
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Upper-extremity surgery
About 23921: Secondary closure after shoulder disarticulation
Reports delayed surgical closure of an open shoulder-disarticulation wound when the stump is closed in a separate operative session.
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.
CMS billing rules for 23921
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU5.58 · 41%
- Practice expense (office) RVU6.97 · 51%
- Malpractice RVU1.20 · 9%
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 compared with similar codes
Office rates for Indiana, from the same CMS release.
No office rate
23900 describes a more extensive amputation involving the shoulder girdle. It is not the delayed closure code for a shoulder-disarticulation stump.
No office rate
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.
Compare 23921 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Indiana →
Office / nonfacility
Unavailable
Facility
$421.67
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 23921 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
2,251
- Code
- 23921
- Physician work
- 5.58
- Practice expense
- 6.97
- Malpractice
- 1.20
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.58 | × 1.000 | 5.5800 |
| Practice expense | 6.97 | × 0.927 | 6.4612 |
| Malpractice | 1.20 | × 0.486 | 0.5832 |
| Total RVUs | 12.6244 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Indiana$421.67
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.58 | 1 |
| Practice expense | 6.97 | 0.927 |
| Malpractice | 1.2 | 0.486 |
(5.58 × 1 + 6.97 × 0.927 + 1.2 × 0.486) × $33.4009 = $421.67
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
2,24823802,,Arthrd glenohumeral jt w/grf,A,,17.96,13.61,NA,13.61,,3.83,35.40,35.40,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,24923900,,Interthoracoscplr amputation,A,,20.20,13.13,NA,13.13,,4.30,37.63,37.63,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,25023920,,Disarticulation shoulder,A,,15.82,11.79,NA,11.79,,3.36,30.97,30.97,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,25123921,,Disarticulation sho sec clsr,A,,5.58,6.97,NA,6.97,,1.20,13.75,13.75,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,25223929,,Unlisted procedure shoulder,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,2,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
2,25323930,,I&d upr a/e dp absc/hmtma,A,,2.92,7.88,,2.61,,0.61,11.41,6.14,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,25423931,,I&d upr a/e bursa,A,,1.79,7.56,,2.61,,0.35,9.70,4.75,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915