Billing code 23101: Joint arthrotomyMedicare rate & RVUs in Oregon
Open AC or SC joint surgery that includes biopsy, reported when the surgeon opens one of these joints for direct access or tissue sampling.
CMS doesn’t publish an office rate for 23101 in Oregon.
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 23101 covers
The surgeon opens the acromioclavicular (AC) or sternoclavicular (SC) joint through an incision to access the joint directly; biopsy is included when performed. Orthopedic surgeons commonly perform this procedure in a hospital or ambulatory surgery center when direct examination or tissue sampling is needed, such as evaluating a suspected joint infection or inflammatory process.
Select the code based on the joint and the documented open procedure, not simply the diagnosis. The operative report should identify the AC or SC joint, side, surgical approach, and whether tissue was sampled. The day-before preoperative visit and 90 days of related postoperative care are included in the global period. For multiple procedures 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 services are not paid; 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.
Where 23101 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $460.38 |
| Rest Of Oregon | Unavailable | $430.79 |
How the 23101 rate is calculated
Each of 23101’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 · 23101
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 5.58Practice expense 6.50Malpractice 1.20
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 23101
23101 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 23101
Joint 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) | 1 | Not paid (statutory restriction). |
| 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 · 23101
Joint 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
23101 without 50 · national facility
$443.56
Joint arthrotomy
23101-50 · Bilateral: 150%
$665.34
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).
23101 compared with similar codes
Compare codes
23101 vs 23100 vs 23106 vs 23120: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 23100Shoulder arthrotomy
- Choose 23100 for arthrotomy involving the glenohumeral joint, not the AC or SC joint.
- 23106Joint surgery
- 23106 applies to sternoclavicular arthrotomy with synovectomy; 23101 covers AC or SC arthrotomy that includes biopsy.
- 23120Clavicle resection
- 23120 is partial clavicle resection. It represents bone removal, not opening the AC or SC joint for access or biopsy.
23101 billing questions
How is 23101 distinguished from 23100?
23101 is for an open AC or SC joint procedure that includes biopsy; 23100 is for the glenohumeral joint. The operative note should make the joint site clear.
Can the biopsy be reported separately?
Biopsy is included when performed through the arthrotomy reported with 23101. Do not report the same joint tissue sampling as a separate biopsy service.
When is 23106 a closer fit?
23106 describes sternoclavicular arthrotomy with synovectomy. Use the code matching the documented procedure rather than treating a synovectomy as a biopsy.
How is bilateral surgery reported?
When the procedure is performed on both sides, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant-at-surgery claim be submitted?
CMS does not pay an assistant at surgery for this code under the statutory restriction.
What documentation supports 23101?
Document the AC or SC joint, laterality, open approach, and the work performed, including any biopsy. The operative report should distinguish this joint procedure from glenohumeral surgery or clavicle resection.
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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