Billing code 23420: Rotator cuff surgeryMedicare rate & RVUs in Utah
Reconstructs a chronic, complete rotator cuff avulsion when the extent of the tear calls for more than a routine cuff repair.
CMS doesn’t publish an office rate for 23420 in Utah.
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 23420 covers
An orthopedic surgeon uses this service to reconstruct a chronic, complete rotator cuff avulsion, typically in an operative setting. The work addresses a longstanding, extensive cuff injury rather than an acute tear or a more limited chronic cuff repair. Acromioplasty is included, so it is part of the reported reconstruction rather than a separate service under this code.
Select the code when the operative report supports chronicity, complete avulsion, and reconstruction; document the tear and the repair performed. This major procedure has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. 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.
23420 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $874.68 |
How the 23420 rate is calculated
Each of 23420’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 · 23420
RVUs × geographic indexes × conversion factor
Work13.20
13.20 RVUs× 1.000 GPCI
Practice expense11.17
11.17 RVUs× 1.000 GPCI
Malpractice2.77
2.77 RVUs× 1.000 GPCI
Adjusted RVUs
27.1400
Conversion factor
$33.4009
Medicare rate
$906.50
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 23420
23420 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 23420
Rotator cuff surgery
| 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 · 23420
Rotator cuff surgery
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
23420 without 50 · national facility
$906.50
Rotator cuff surgery
23420-50 · Bilateral: 150%
$1,359.75
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).
23420 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 23410Rotator cuff repair
- 23410 addresses acute rotator cuff repair. Choose 23420 for chronic, complete avulsion requiring reconstruction.
- 23412Rotator cuff repair
- 23412 is for chronic cuff repair; 23420 represents reconstruction of a chronic, complete avulsion and includes acromioplasty.
- 29827Rotator cuff repair
- 29827 reports arthroscopic rotator cuff repair. Use 23420 when the documented service is the reconstruction represented by this code, not an arthroscopic repair.
23420 billing questions
When should this be chosen over 23412?
Use 23420 for a chronic, complete cuff avulsion requiring reconstruction. A chronic cuff repair without that reconstructive scope is more consistent with 23412.
Is acromioplasty separately reported?
Acromioplasty is included in 23420. Do not report it separately as work included in this reconstruction.
How is bilateral surgery reported?
For a bilateral procedure, report modifier 50; CMS pays the service at 150% under the stated bilateral rule.
Does the code include postoperative visits?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation, while team surgery is not permitted.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in the session are paid at 50% under the multiple procedure rule.
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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