No office rate
Choose 23465 for a posterior capsular repair. Code 23466 is for multidirectional instability.
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CMS RVU26D · Effective 2026-10-01
23465 Shoulder capsule repair Medicare reimbursement rates in Massachusetts
Surgical tightening of the posterior shoulder capsule, with or without a bone-block technique, treats glenohumeral instability directed toward the back of the joint. Compare 23465 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 23465 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
No supported rate
Facility setting
$1030.51–$1108.02
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 23465: Posterior shoulder capsular repair
Surgical tightening of the posterior shoulder capsule, with or without a bone-block technique, treats glenohumeral instability directed toward the back of the joint.
An orthopedic surgeon uses this procedure to tighten the posterior shoulder capsule when the humeral head is unstable toward the back of the glenohumeral joint. The repair may include a bone-block technique. It is generally performed in an operating room for patients with posterior instability; the operative report should make clear the direction of instability and the repair performed.
Report the code when the documented procedure is a posterior capsular repair, not an anterior or multidirectional repair. The operative note should support the capsule addressed and describe any bone-block work. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued is paid in full and other procedures are subject to the standard 50% reduction. For bilateral reporting with modifier 50, CMS pays 150%. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 23465
- 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 RVU15.89 · 52%
- Practice expense (office) RVU11.41 · 37%
- Malpractice RVU3.38 · 11%
24
Medicare services in 2024 · #5804 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.
23465 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
Code 23450 addresses anterior capsular repair; 23465 addresses posterior instability.
No office rate
Code 23455 is an anterior repair that includes labral repair. It is not the posterior repair represented by 23465.
No office rate
Code 23460 describes an anterior repair with a bone-block technique; 23465 is selected for posterior capsular repair.
Compare 23465 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
Unavailable
Facility
$1108.02
Rest Of Massachusetts →
Office / nonfacility
Unavailable
Facility
$1030.51
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23465 billing questions
How does this differ from code 23466?
Use this code for a posterior capsular repair. Code 23466 describes repair for multidirectional shoulder instability.
Is this the code for an anterior Bankart-type repair?
No. This code is for posterior capsular repair; anterior repair with labral repair is represented by code 23455.
How is bilateral surgery reported under the CMS facts?
Report bilateral surgery with modifier 50. CMS pays the bilateral procedure at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon or co-surgeon be paid?
Assistant-at-surgery payment may be made. Co-surgeons are paid only when supporting documentation is provided.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction, with payment at 50%.
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.
2,20523455,,Repair shoulder capsule,A,,14.30,9.33,NA,9.33,,2.73,26.36,26.36,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,20623460,,Repair shoulder capsule,A,,15.42,11.26,NA,11.26,,3.28,29.96,29.96,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,20723462,,Repair shoulder capsule,A,,15.33,10.67,NA,10.67,,3.26,29.26,29.26,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,20823465,,Repair shoulder capsule,A,,15.89,11.41,NA,11.41,,3.38,30.68,30.68,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,20923466,,Repair shoulder capsule,A,,15.41,12.43,NA,12.43,,3.14,30.98,30.98,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,21023470,,Reconstruct shoulder joint,A,,17.44,11.57,NA,11.57,,3.56,32.57,32.57,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,21123472,,Reconstruct shoulder joint,A,,21.58,12.99,NA,12.99,,4.36,38.93,38.93,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00