$237.98–$261.37
23065 is for superficial shoulder-area tissue. Choose 23066 when the sampled tissue is documented as deep.
On this page
CMS RVU26D · Effective 2026-10-01
23066 Shoulder biopsy Medicare reimbursement rates in Massachusetts
Report this code for operative biopsy sampling of deep soft tissue in the shoulder area when tissue is obtained for diagnostic evaluation. Compare 23066 office and facility rates across CMS payment localities in Massachusetts.
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 23066 in Massachusetts?
Massachusetts 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
$645.71–$716.21
2 of 2 localities have a supported rate.
Facility setting
$372.78–$406.74
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 23066: Deep shoulder soft tissue biopsy
Report this code for operative biopsy sampling of deep soft tissue in the shoulder area when tissue is obtained for diagnostic evaluation.
This code represents operative sampling of deep soft tissue in the shoulder area for diagnostic evaluation, such as assessment of an indeterminate mass or other abnormal tissue. An orthopedic surgeon or other surgeon exposes the target tissue and removes a specimen for examination. It is distinct from a superficial shoulder-tissue biopsy and from an operation that removes the entire lesion. The service is generally performed in an operating room or other surgical setting.
Select the code based on the documented depth and the fact that tissue was sampled rather than the full lesion excised. The operative report should identify the shoulder site, the deep tissue sampled, and the biopsy performed. This major surgery has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed 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%. Medicare does not pay an assistant at surgery; co-surgeons and team surgery are not permitted.
CMS billing rules for 23066
- 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 RVU4.19 · 22%
- Practice expense (office) RVU13.62 · 73%
- Malpractice RVU0.92 · 5%
268
Medicare services in 2024 · #4081 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.
23066 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
23076 describes excision of a deep shoulder tumor smaller than 5 cm. Use 23066 when the operation samples tissue rather than removing the lesion.
No office rate
23073 describes excision of a deep shoulder tumor 5 cm or larger. A diagnostic sample without removal of the full lesion points to 23066.
Compare 23066 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
Metropolitan Boston →
Office / nonfacility
$716.21
Facility
$406.74
Rest Of Massachusetts →
Office / nonfacility
$645.71
Facility
$372.78
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23066 billing questions
How does this differ from 23065?
23066 is for biopsy of deep shoulder-area tissue; 23065 is the superficial-tissue sibling. The operative documentation should support the depth selected.
When should an excision code be considered instead?
Use an applicable shoulder-lesion excision code when the operation removes the lesion rather than taking a diagnostic sample. Deep excision codes are selected in part by lesion size.
Is the pathologist's examination included?
This code represents the surgeon's operative tissue sampling. A pathologist's examination is a distinct service when performed and appropriately reported.
What is included in the global period?
The 90-day global includes the related preoperative visit on the day before surgery and related postoperative care for 90 days.
How are bilateral biopsies and other same-session procedures handled?
Bilateral reporting with modifier 50 is paid at 150%. For multiple procedures in one session, the highest-valued procedure is paid in full and the others at 50%.
Can an assistant or co-surgeon be reported?
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.
2,15323040,,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
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