No office rate
23920 removes the arm through the shoulder joint. 23900 describes the more extensive forequarter amputation involving shoulder-girdle structures.
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CMS RVU26D · Effective 2026-10-01
23920 Shoulder amputation Medicare reimbursement rates in Vermont
Reports removal of an upper extremity through the shoulder joint, typically when trauma, tumor, or disease makes the limb unsalvageable. Compare 23920 office and facility rates across CMS payment localities in Vermont.
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 23920 in Vermont?
Vermont 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
No supported rate
Facility setting
$975.05
1 of 1 localities have a supported rate.
Payment area: Vermont
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.
Orthopedic surgery
About 23920: Shoulder joint disarticulation
Reports removal of an upper extremity through the shoulder joint, typically when trauma, tumor, or disease makes the limb unsalvageable.
This operation removes the arm at the shoulder joint. It may be performed for a severely damaged, nonviable limb or to treat a tumor or other disease that cannot be managed with a more distal amputation. Orthopedic, trauma, or musculoskeletal oncology surgeons typically perform it in an operating room. The level is the shoulder joint, rather than a forequarter amputation that also removes the scapula and part of the clavicle.
Report 23920 when the operative record supports disarticulation at the shoulder joint; document the indication, amputation level, and extent of removal. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and others at 50%. A bilateral procedure reported with modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 23920
- 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
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU15.82 · 51%
- Practice expense (office) RVU11.79 · 38%
- Malpractice RVU3.36 · 11%
22
Medicare services in 2024 · #5855 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.
23920 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
23920 reports the shoulder disarticulation; 23921 applies to secondary closure after that amputation.
23929
No office rateUnlisted procedure shoulder
Use 23920 when the operation is a shoulder-joint disarticulation. 23929 is for a shoulder procedure without a more specific code.
Compare 23920 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
Vermont →
Office / nonfacility
Unavailable
Facility
$975.05
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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 23920 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
2,250
- Code
- 23920
- Physician work
- 15.82
- Practice expense
- 11.79
- Malpractice
- 3.36
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 15.82 | × 1.000 | 15.8200 |
| Practice expense | 11.79 | × 0.990 | 11.6721 |
| Malpractice | 3.36 | × 0.506 | 1.7002 |
| Total RVUs | 29.1923 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$975.05
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 15.82 | 1 |
| Practice expense | 11.79 | 0.99 |
| Malpractice | 3.36 | 0.506 |
(15.82 × 1 + 11.79 × 0.99 + 3.36 × 0.506) × $33.4009 = $975.05
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.
23920 billing questions
How is 23920 distinguished from a forequarter amputation?
23920 describes removal through the shoulder joint. A forequarter amputation removes additional shoulder-girdle structures and is represented by 23900.
When is 23921 used instead?
23921 is for secondary closure after shoulder disarticulation, not the initial amputation. Use 23920 for the disarticulation itself.
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 a bilateral procedure reported?
CMS identifies this as a bilateral procedure; when reported with modifier 50, it is paid at 150%.
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.
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.
2,24723800,,Arthrodesis glenohumeral jt,A,,14.36,10.93,NA,10.93,,3.05,28.34,28.34,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,24823802,,Arthrd glenohumeral jt w/grf,A,,17.96,13.61,NA,13.61,,3.83,35.40,35.40,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,24923900,,Interthoracoscplr amputation,A,,20.20,13.13,NA,13.13,,4.30,37.63,37.63,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,25023920,,Disarticulation shoulder,A,,15.82,11.79,NA,11.79,,3.36,30.97,30.97,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,25123921,,Disarticulation sho sec clsr,A,,5.58,6.97,NA,6.97,,1.20,13.75,13.75,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,25223929,,Unlisted procedure shoulder,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,2,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
2,25323930,,I&d upr a/e dp absc/hmtma,A,,2.92,7.88,,2.61,,0.61,11.41,6.14,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817