No office rate
Choose 23100 for arthrotomy involving the glenohumeral joint, not the AC or SC joint.
On this page
CMS RVU26D · Effective 2026-10-01
23101 Joint arthrotomy Medicare reimbursement rates in Kansas
Open AC or SC joint surgery that includes biopsy, reported when the surgeon opens one of these joints for direct access or tissue sampling. Compare 23101 office and facility rates across CMS payment localities in Kansas.
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 23101 in Kansas?
Kansas 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
$402.84
1 of 1 localities have a supported rate.
Payment area: Kansas
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 23101: Acromioclavicular or sternoclavicular arthrotomy
Open AC or SC joint surgery that includes biopsy, reported when the surgeon opens one of these joints for direct access or tissue sampling.
The surgeon opens the acromioclavicular (AC) or sternoclavicular (SC) joint through an incision to access the joint directly; biopsy is included when performed. Orthopedic surgeons commonly perform this procedure in a hospital or ambulatory surgery center when direct examination or tissue sampling is needed, such as evaluating a suspected joint infection or inflammatory process.
Select the code based on the joint and the documented open procedure, not simply the diagnosis. The operative report should identify the AC or SC joint, side, surgical approach, and whether tissue was sampled. The day-before preoperative visit and 90 days of related postoperative care are included in the global period. For multiple procedures in the same session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery services are not paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 23101
- 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 paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU5.58 · 42%
- Practice expense (office) RVU6.50 · 49%
- Malpractice RVU1.20 · 9%
49
Medicare services in 2024 · #5362 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.
23101 compared with similar codes
Office rates for Kansas, from the same CMS release.
No office rate
23106 applies to sternoclavicular arthrotomy with synovectomy; 23101 covers AC or SC arthrotomy that includes biopsy.
No office rate
23120 is partial clavicle resection. It represents bone removal, not opening the AC or SC joint for access or biopsy.
Compare 23101 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
Kansas →
Office / nonfacility
Unavailable
Facility
$402.84
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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 23101 in Kansas.
PPRRVU2026_Oct_nonQPP.csv
2,164
- Code
- 23101
- Physician work
- 5.58
- Practice expense
- 6.50
- Malpractice
- 1.20
GPCI2026.csv
54
- Locality
- Kansas
- Physician work
- 1.000
- Practice expense
- 0.904
- Malpractice
- 0.504
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.58 | × 1.000 | 5.5800 |
| Practice expense | 6.50 | × 0.904 | 5.8760 |
| Malpractice | 1.20 | × 0.504 | 0.6048 |
| Total RVUs | 12.0608 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kansas$402.84
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.58 | 1 |
| Practice expense | 6.5 | 0.904 |
| Malpractice | 1.2 | 0.504 |
(5.58 × 1 + 6.5 × 0.904 + 1.2 × 0.504) × $33.4009 = $402.84
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.
23101 billing questions
How is 23101 distinguished from 23100?
23101 is for an open AC or SC joint procedure that includes biopsy; 23100 is for the glenohumeral joint. The operative note should make the joint site clear.
Can the biopsy be reported separately?
Biopsy is included when performed through the arthrotomy reported with 23101. Do not report the same joint tissue sampling as a separate biopsy service.
When is 23106 a closer fit?
23106 describes sternoclavicular arthrotomy with synovectomy. Use the code matching the documented procedure rather than treating a synovectomy as a biopsy.
How is bilateral surgery reported?
When the procedure is performed on both sides, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant-at-surgery claim be submitted?
CMS does not pay an assistant at surgery for this code under the statutory restriction.
What documentation supports 23101?
Document the AC or SC joint, laterality, open approach, and the work performed, including any biopsy. The operative report should distinguish this joint procedure from glenohumeral surgery or clavicle resection.
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.
2,16123077,,Rad rescj tum shoulder<5 cm,A,,17.22,10.33,NA,10.33,,3.93,31.48,31.48,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,16223078,,Rad rescj tum shoulder 5cm/>,A,,21.99,12.68,NA,12.68,,5.02,39.69,39.69,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,16323100,,Arthrotomy glenhumrl jt w/bx,A,,6.05,7.37,NA,7.37,,1.29,14.71,14.71,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,16423101,,Arthrt acrmclv/strnclav jt,A,,5.58,6.50,NA,6.50,,1.20,13.28,13.28,0,090,0.10,0.69,0.21,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,16523105,,Arthrotomy glenohumeral jt,A,,8.27,8.13,NA,8.13,,1.72,18.12,18.12,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,16623106,,Arthrotomy strnclav joint,A,,5.98,7.35,NA,7.35,,1.28,14.61,14.61,0,090,0.10,0.69,0.21,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,16723107,,Arthrt glenhumrl jt w/expl,A,,8.65,8.30,NA,8.30,,1.80,18.75,18.75,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958