Billing code 23440: Biceps tenodesisMedicare rate & RVUs in Texas
Reports shoulder surgery that relocates and secures the long-head biceps tendon as part of a tendon transfer for selected biceps tendon disorders.
CMS doesn’t publish an office rate for 23440 in Texas.
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 23440 covers
This operation addresses disease or instability involving the long head of the biceps tendon at the shoulder. The surgeon releases the tendon from its usual attachment and relocates or secures it as part of a tendon transfer. Orthopedic surgeons commonly perform the procedure in a hospital outpatient department or ambulatory surgery center, often during surgery for associated shoulder pathology. The operative report should establish the tendon treated and describe the transfer and fixation performed.
Report this service when the documented work supports a tendon transfer, rather than a routine biceps tenodesis alone. The 90-day global period includes 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 other procedures are subject to the standard multiple procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeon payment requires 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 23440 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $710.24 |
| Beaumont | Unavailable | $670.84 |
| Brazoria | Unavailable | $685.70 |
| Dallas | Unavailable | $693.11 |
| Fort Worth | Unavailable | $691.23 |
| Galveston | Unavailable | $689.75 |
| Houston | Unavailable | $729.46 |
| Rest Of Texas | Unavailable | $679.98 |
How the 23440 rate is calculated
Each of 23440’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 · 23440
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 10.37Practice expense 8.46Malpractice 2.17
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 23440
23440 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 23440
Biceps tenodesis
| 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 · 23440
Biceps tenodesis
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
23440 without 50 · national facility
$701.42
Biceps tenodesis
23440-50 · Bilateral: 150%
$1,052.13
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).
23440 compared with similar codes
Compare codes
23440 vs 23430 vs 23405 vs 23410: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 23430Biceps surgery
- Use 23430 for routine tenodesis of the long-head biceps tendon. This code describes the transfer-based shoulder procedure.
- 23405Shoulder tenotomy
- Code 23405 represents a shoulder-area tendon incision, not relocation and securing of the biceps tendon as part of a transfer.
- 23410Rotator cuff repair
- Code 23410 reports repair of an acute rotator cuff rupture. It does not represent biceps tendon transfer, though both procedures may be performed in one session.
23440 billing questions
How does this differ from a routine biceps tenodesis?
This code is for biceps tendon work that includes a tendon transfer. A routine long-head biceps tenodesis without that transfer is generally reported with 23430.
What should the operative report document?
Document the long-head biceps tendon treated, the transfer performed, and how the tendon was relocated or secured. The record should distinguish the transfer from routine tenodesis alone.
Can this be reported with rotator cuff surgery?
It may be performed during the same session as a rotator cuff repair when each procedure is separately supported by the operative work. Same-session procedures are subject to the standard multiple procedure reduction.
How is bilateral surgery reported?
For bilateral performance, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery services may be paid. Co-surgeon payment requires supporting documentation, while team surgery is not permitted.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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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