Billing code 23100: Shoulder arthrotomyMedicare rate & RVUs in Ohio
Reports open entry into the shoulder’s glenohumeral joint to obtain tissue for biopsy, such as when joint disease requires direct tissue sampling.
CMS doesn’t publish an office rate for 23100 in Ohio.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 23100 covers
An orthopedic surgeon opens the glenohumeral joint and obtains tissue for diagnostic examination. This may be done when direct tissue sampling is needed to investigate suspected infection, inflammatory disease, or an abnormal synovial or joint finding. The service is an open operation, not a needle aspiration or an arthroscopic procedure. It is typically performed in a hospital or ambulatory surgery setting, with the specimen submitted for appropriate examination.
The operative report should identify the glenohumeral joint, describe the open approach and biopsy, and state the clinical reason for sampling. This major surgery has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When other procedures occur 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 payment may be made; co-surgeons require supporting documentation, and team surgery is not permitted.
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.
23100 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $470.26 |
How the 23100 rate is calculated
Each of 23100’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 23100
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 6.05Practice expense 7.37Malpractice 1.29
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 23100
23100 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 23100
Shoulder arthrotomy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 23100
Shoulder arthrotomy
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
23100 without 50 · national facility
$491.33
Shoulder arthrotomy
23100-50 · Bilateral: 150%
$737.00
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
23100 compared with similar codes
Compare codes
23100 vs 23105 vs 23107 vs 20610 vs 23101: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 23105Shoulder synovectomy
- Both involve open glenohumeral surgery, but 23105 is used for the arthrotomy service that includes synovectomy rather than biopsy as the defining service.
- 23107Shoulder arthrotomy
- Use 23107 when the operative service is exploration, drainage, or foreign-body removal; use 23100 when the documented service includes biopsy.
- 20610Joint injection
- 20610 describes needle aspiration and/or injection of a major joint. It does not describe an open tissue biopsy of the glenohumeral joint.
- 23101Joint arthrotomy
- 23101 concerns arthrotomy with biopsy at the acromioclavicular or sternoclavicular joint, not the glenohumeral joint.
23100 billing questions
When is this code appropriate instead of a shoulder-joint aspiration?
Use this code for open tissue biopsy of the glenohumeral joint. A needle aspiration obtains joint fluid rather than tissue and may be reported with 20610 when that service is performed.
Does this code describe an arthroscopic biopsy?
No. It describes an open approach to the glenohumeral joint; document the surgical approach and tissue obtained.
How does this differ from the glenohumeral arthrotomy code for exploration?
This code is for an arthrotomy with biopsy. Code 23107 describes a different operative purpose involving exploration, drainage, or foreign-body removal.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How is bilateral performance handled?
When the procedure is performed bilaterally, modifier 50 applies, with payment at 150% under the CMS facts for this code.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeons are paid only with supporting documentation; team surgery is 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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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