No office rate
Use 23077 for radical resection of a shoulder-area tumor smaller than 5 cm; 23078 applies at 5 cm or larger.
On this page
CMS RVU26D · Effective 2026-10-01
23078 Shoulder tumor resection Medicare reimbursement rates in Maine
Reports radical removal of a shoulder-area soft-tissue tumor measuring at least 5 cm, typically when oncologic resection requires removal beyond a simple local excision. Compare 23078 office and facility rates across CMS payment localities in Maine.
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 23078 in Maine?
Maine has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1228.42–$1260.00
2 of 2 localities have a supported rate.
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 23078: Radical shoulder tumor resection, 5 cm or larger
Reports radical removal of a shoulder-area soft-tissue tumor measuring at least 5 cm, typically when oncologic resection requires removal beyond a simple local excision.
This code describes radical resection of a soft-tissue tumor in the shoulder area measuring 5 cm or larger. It is commonly used for oncologic operations, such as resection of a suspected or confirmed soft-tissue sarcoma, and is typically performed by an orthopedic oncologic or other qualified surgeon in an operating room. The operative work is more extensive than a routine local excision; the surgeon documents the tumor’s location, size, depth, and the extent of tissue removed.
Select this code when the procedure is a radical resection and the tumor meets the size threshold, rather than a deep-tumor excision or a biopsy. The operative report should support the shoulder-area site, measured size, and radical nature of the removal. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 23078
- 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
- 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 RVU21.99 · 55%
- Practice expense (office) RVU12.68 · 32%
- Malpractice RVU5.02 · 13%
263
Medicare services in 2024 · #4094 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.
23078 compared with similar codes
Office rates for Maine, from the same CMS release.
No office rate
Use 23073 for excision of a deep shoulder tumor measuring 5 cm or larger. Use 23078 when the documented operation is a radical resection.
$577.59–$610.17
23066 reports biopsy of shoulder tissue for diagnostic sampling. It does not describe definitive radical tumor resection.
Compare 23078 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.
2 of 2 payment localities
Rest Of Maine →
Office / nonfacility
Unavailable
Facility
$1228.42
Southern Maine →
Office / nonfacility
Unavailable
Facility
$1260.00
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23078 billing questions
When should I choose 23078 instead of 23077?
Both describe radical resection of a shoulder-area tumor, but 23078 is for a tumor measuring 5 cm or larger. Code 23077 is for a tumor smaller than 5 cm.
How is 23078 different from 23073?
23078 represents radical resection of a tumor measuring at least 5 cm. Code 23073 describes excision of a deep shoulder tumor of that size, rather than radical resection.
What documentation supports reporting 23078?
The operative report should identify the shoulder-area tumor, document its size as at least 5 cm, and describe the extent of the radical resection.
Does the 90-day global period include postoperative visits?
Yes. The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided; team surgery is not permitted.
How is bilateral reporting handled?
When the procedure is performed bilaterally and reported with modifier 50, CMS pays 150% under the stated bilateral rule.
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.
2,15923075,,Exc shoulder les sc < 3 cm,A,,4.10,11.59,,4.60,,0.92,16.61,9.62,0,090,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,16023076,,Exc shoulder tum deep < 5 cm,A,,7.22,6.82,NA,6.82,,1.63,15.67,15.67,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,16123077,,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