$572.49
Use 23065 for a deep soft-tissue target in the shoulder region; 23066 is for biopsy of bone in that region.
On this page
CMS RVU26D · Effective 2026-10-01
23065 Shoulder biopsy Medicare reimbursement rates in Kentucky
Report this code for an open biopsy of deep soft tissue in the shoulder region when tissue is sampled for diagnosis rather than completely excised. Compare 23065 office and facility rates across CMS payment localities in Kentucky.
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 23065 in Kentucky?
Kentucky 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
$214.38
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
Facility setting
$138.96
1 of 1 localities have a supported rate.
Payment area: Kentucky
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.
Musculoskeletal surgery
About 23065: Deep shoulder soft-tissue biopsy
Report this code for an open biopsy of deep soft tissue in the shoulder region when tissue is sampled for diagnosis rather than completely excised.
This service involves surgically obtaining a tissue sample from deep soft tissue in the shoulder region, such as a deep soft-tissue mass. The surgeon makes an incision to reach the target and removes tissue for diagnostic examination; the procedure is a biopsy, not complete removal of a lesion. Orthopedic surgeons and other surgeons who evaluate shoulder-region masses may perform it in an outpatient operating room or hospital setting.
Select the code when the sampled structure is deep shoulder soft tissue. A record supporting the claim identifies the target and its location, documents the approach and tissue obtained, and distinguishes sampling from complete excision. The code has a 10-day global period, so related postoperative visits during that period are included. For bilateral procedures, modifier 50 is paid at 150%. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 23065
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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 RVU2.24 · 32%
- Practice expense (office) RVU4.34 · 63%
- Malpractice RVU0.35 · 5%
276
Medicare services in 2024 · #4055 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.
23065 compared with similar codes
Office rates for Kentucky, from the same CMS release.
No office rate
This code describes deep soft-tissue sampling for diagnosis. Code 23071 is for complete excision of a subcutaneous shoulder lesion measuring 3 cm or more.
No office rate
Use this code when deep shoulder soft tissue is sampled for diagnosis. Code 23073 describes complete excision of a deep shoulder tumor measuring 5 cm or more.
Compare 23065 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
Kentucky →
Office / nonfacility
$214.38
Facility
$138.96
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 23065 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
2,155
- Code
- 23065
- Physician work
- 2.24
- Practice expense
- 4.34
- Malpractice
- 0.35
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.24 | × 1.000 | 2.2400 |
| Practice expense | 4.34 | × 0.889 | 3.8583 |
| Malpractice | 0.35 | × 0.915 | 0.3202 |
| Total RVUs | 6.4185 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$214.38
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.24 | 1 |
| Practice expense | 4.34 | 0.889 |
| Malpractice | 0.35 | 0.915 |
(2.24 × 1 + 4.34 × 0.889 + 0.35 × 0.915) × $33.4009 = $214.38
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.24 | 1 |
| Practice expense | 1.8 | 0.889 |
| Malpractice | 0.35 | 0.915 |
(2.24 × 1 + 1.8 × 0.889 + 0.35 × 0.915) × $33.4009 = $138.96
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.
23065 billing questions
How is this code distinguished from 23066?
This code is for a deep soft-tissue biopsy in the shoulder region. Use 23066 when the biopsy target is bone.
Should this code be used when the entire mass is removed?
No. It represents sampling for diagnosis, not complete lesion excision. For a complete excision, select the applicable shoulder excision code based on tissue depth and lesion size.
What documentation supports reporting this biopsy?
Document the shoulder-region target, that it is deep soft tissue, the biopsy approach, and the tissue sampled. The operative record should make clear that tissue was obtained for diagnosis rather than the lesion being completely excised.
Are related postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in this procedure's payment.
How does Medicare handle bilateral biopsies or another procedure in the same session?
A bilateral procedure reported with modifier 50 is paid at 150%. For multiple procedures in the same session, the highest-valued procedure is paid in full and the others are reduced to 50%.
Can an assistant or another surgeon be reported for this procedure?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are 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.
2,15223035,,Incision bone cortex sho,A,,8.93,8.23,NA,8.23,,1.84,19.00,19.00,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,15323040,,Arthrt gh jt expl/drg/rmv fb,A,,9.51,8.68,NA,8.68,,1.96,20.15,20.15,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,15423044,,Arthrt ac sc jt exp/rmvl fb,A,,7.40,7.22,NA,7.22,,1.64,16.26,16.26,0,090,0.10,0.69,0.21,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,15523065,,Biopsy shoulder tissues,A,,2.24,4.34,,1.80,,0.35,6.93,4.39,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,15623066,,Biopsy shoulder tissues,A,,4.19,13.62,,5.86,,0.92,18.73,10.97,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,15723071,,Exc shoulder les sc 3 cm/>,A,,5.76,5.06,NA,5.06,,1.37,12.19,12.19,0,090,0.10,0.80,0.10,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,15823073,,Exc shoulder tum deep 5 cm/>,A,,9.88,7.57,NA,7.57,,2.27,19.72,19.72,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631