No office rate
Both describe subcutaneous shoulder lesion excision; choose 23071 when the lesion is 3 cm or larger, rather than under 3 cm.
On this page
CMS RVU26D · Effective 2026-10-01
23075 Shoulder excision Medicare reimbursement rates in Rhode Island
Reports surgical removal of a subcutaneous soft-tissue lesion in the shoulder area when the lesion measures less than 3 cm. Compare 23075 office and facility rates across CMS payment localities in Rhode Island.
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 23075 in Rhode Island?
Rhode Island has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$566.85
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
Facility setting
$325.67
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
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.
Musculoskeletal surgery
About 23075: Subcutaneous shoulder lesion excision under 3 cm
Reports surgical removal of a subcutaneous soft-tissue lesion in the shoulder area when the lesion measures less than 3 cm.
A surgeon removes a soft-tissue lesion from the subcutaneous layer of the shoulder area, such as a small lipoma, rather than sampling it for diagnosis alone. The procedure may be performed in an office-based operating room or a hospital or ambulatory surgery facility. The key distinctions are the lesion’s size and its depth: it is under 3 cm and remains superficial to the deep fascia.
The operative report should identify the shoulder site, lesion size, tissue plane, and whether the lesion was excised. This major surgery code has 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 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 and team surgery are not permitted.
CMS billing rules for 23075
- 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 RVU4.10 · 25%
- Practice expense (office) RVU11.59 · 70%
- Malpractice RVU0.92 · 6%
673
Medicare services in 2024 · #3293 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.
23075 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
Use 23076 for a deep shoulder soft-tissue tumor under 5 cm. This code is for a subcutaneous lesion under 3 cm.
$236.41
Use 23065 when shoulder tissue is biopsied for diagnosis rather than excised as a lesion.
Compare 23075 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.
1 of 1 payment localities
Rhode Island →
Office / nonfacility
$566.85
Facility
$325.67
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 23075 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
2,159
- Code
- 23075
- Physician work
- 4.10
- Practice expense
- 11.59
- Malpractice
- 0.92
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.10 | × 1.019 | 4.1779 |
| Practice expense | 11.59 | × 1.033 | 11.9725 |
| Malpractice | 0.92 | × 0.892 | 0.8206 |
| Total RVUs | 16.9710 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$566.85
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.1 | 1.019 |
| Practice expense | 11.59 | 1.033 |
| Malpractice | 0.92 | 0.892 |
(4.1 × 1.019 + 11.59 × 1.033 + 0.92 × 0.892) × $33.4009 = $566.85
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.1 | 1.019 |
| Practice expense | 4.6 | 1.033 |
| Malpractice | 0.92 | 0.892 |
(4.1 × 1.019 + 4.6 × 1.033 + 0.92 × 0.892) × $33.4009 = $325.67
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
23075 billing questions
When should this be reported instead of 23071?
Use this code for a subcutaneous shoulder lesion under 3 cm. Code 23071 describes the corresponding subcutaneous size category of 3 cm or greater.
How does this differ from 23076?
This code is for a lesion in the subcutaneous layer under 3 cm. Code 23076 describes excision of a deep shoulder soft-tissue tumor under 5 cm.
Can this code be used for a biopsy?
It describes excision, not a diagnostic sample alone. For a shoulder-tissue biopsy, consider the biopsy code that matches the documented tissue depth, such as 23065 for superficial tissue.
What documentation supports the size and depth?
The operative report should state the lesion’s measured size and whether it was confined to subcutaneous tissue or extended below the fascia. Include the shoulder location and the removal performed.
How are bilateral procedures and additional same-session procedures handled?
A bilateral procedure reported with modifier 50 is paid at 150%. For multiple procedures in the same session, the highest-valued procedure is paid in full and the others 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.
2,15623066,,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
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
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537