No office rate
This code describes a transfer of one muscle. Choose 23397 when multiple muscles are transferred.
On this page
CMS RVU26D · Effective 2026-10-01
23395 Muscle transfer Medicare reimbursement rates in Iowa
Reports relocation of one muscle to restore shoulder or upper-arm function, such as a transfer used when a rotator cuff tendon cannot be repaired. Compare 23395 office and facility rates across CMS payment localities in Iowa.
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 23395 in Iowa?
Iowa 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
$1064.58
1 of 1 localities have a supported rate.
Payment area: Iowa
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.
Orthopedic surgery
About 23395: Single-muscle shoulder transfer
Reports relocation of one muscle to restore shoulder or upper-arm function, such as a transfer used when a rotator cuff tendon cannot be repaired.
The surgeon mobilizes one functioning muscle and reattaches it at a different site to restore shoulder or upper-arm movement or stability. Orthopedic surgeons may use a latissimus dorsi transfer for an irreparable posterosuperior rotator cuff tear or a pectoralis major transfer for an irreparable subscapularis deficiency. These procedures are generally performed in an operating room, with the operative report identifying the donor muscle and its new attachment.
Select this code when the operation transfers one muscle; a transfer involving multiple muscles belongs to the multiple-muscle code. Documentation should describe the functional problem, the muscle transferred, and the operative work performed. Medicare 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 other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 23395
- 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU18.08 · 51%
- Practice expense (office) RVU13.46 · 38%
- Malpractice RVU3.72 · 11%
3.3K
Medicare services in 2024 · #2110 by national volume
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.
23395 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
This code is for transferring a muscle to restore function; 23412 describes repair of a chronic rotator cuff tear.
No office rate
This code covers a single-muscle transfer. Code 23420 is for reconstruction of a chronic complete cuff avulsion.
Compare 23395 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
Iowa →
Office / nonfacility
Unavailable
Facility
$1064.58
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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 23395 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
2,193
- Code
- 23395
- Physician work
- 18.08
- Practice expense
- 13.46
- Malpractice
- 3.72
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 18.08 | × 1.000 | 18.0800 |
| Practice expense | 13.46 | × 0.915 | 12.3159 |
| Malpractice | 3.72 | × 0.397 | 1.4768 |
| Total RVUs | 31.8727 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$1064.58
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 18.08 | 1 |
| Practice expense | 13.46 | 0.915 |
| Malpractice | 3.72 | 0.397 |
(18.08 × 1 + 13.46 × 0.915 + 3.72 × 0.397) × $33.4009 = $1064.58
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.
23395 billing questions
When should I report this code instead of 23397?
Report this code for a transfer involving one muscle. Use 23397 when the operation transfers multiple muscles.
Can this code be reported for a rotator cuff repair?
Use it when the surgeon transfers a muscle to restore function, such as for an irreparable cuff deficiency. A repair of a repairable chronic cuff tear is a different service.
What operative documentation supports this code?
The report should identify the muscle moved, its new attachment, and the shoulder or upper-arm functional problem addressed. It should make clear whether one muscle or multiple muscles were transferred.
Does modifier 50 apply when both shoulders are treated?
Modifier 50 is inappropriate for this code. Do not submit it as a bilateral service.
How does the global period affect postoperative reporting?
The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care. Related routine follow-up during that period is included.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. 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 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.
2,19023334,,Shoulder prosthesis removal,A,,15.11,11.05,NA,11.05,,3.06,29.22,29.22,0,090,0.10,0.69,0.21,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,19123335,,Shoulder prosthesis removal,A,,18.53,12.10,NA,12.10,,3.75,34.38,34.38,0,090,0.10,0.69,0.21,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,19223350,,Injection for shoulder x-ray,A,,0.98,3.63,,0.19,,0.09,4.70,1.26,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,19323395,,Muscle transfer shoulder/arm,A,,18.08,13.46,NA,13.46,,3.72,35.26,35.26,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,19423397,,Muscle transfers,A,,16.34,11.40,NA,11.40,,3.48,31.22,31.22,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,19523400,,Fixation of shoulder blade,A,,13.52,10.50,NA,10.50,,2.89,26.91,26.91,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,19623405,,Incision of tendon & muscle,A,,8.33,7.31,NA,7.31,,1.56,17.20,17.20,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136