No office rate
Both involve open glenohumeral surgery, but 23105 is used for the arthrotomy service that includes synovectomy rather than biopsy as the defining service.
On this page
CMS RVU26D · Effective 2026-10-01
23100 Shoulder arthrotomy Medicare reimbursement rates in Wisconsin
Reports open entry into the shoulder’s glenohumeral joint to obtain tissue for biopsy, such as when joint disease requires direct tissue sampling. Compare 23100 office and facility rates across CMS payment localities in Wisconsin.
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 23100 in Wisconsin?
Wisconsin 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
$451.17
1 of 1 localities have a supported rate.
Payment area: Wisconsin
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 23100: Open glenohumeral joint biopsy
Reports open entry into the shoulder’s glenohumeral joint to obtain tissue for biopsy, such as when joint disease requires direct tissue sampling.
An orthopedic surgeon opens the glenohumeral joint and obtains tissue for diagnostic examination. This may be done when direct tissue sampling is needed to investigate suspected infection, inflammatory disease, or an abnormal synovial or joint finding. The service is an open operation, not a needle aspiration or an arthroscopic procedure. It is typically performed in a hospital or ambulatory surgery setting, with the specimen submitted for appropriate examination.
The operative report should identify the glenohumeral joint, describe the open approach and biopsy, and state the clinical reason for sampling. This major surgery has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When other 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 payment may be made; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 23100
- 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 RVU6.05 · 41%
- Practice expense (office) RVU7.37 · 50%
- Malpractice RVU1.29 · 9%
26
Medicare services in 2024 · #5746 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.
23100 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
No office rate
Use 23107 when the operative service is exploration, drainage, or foreign-body removal; use 23100 when the documented service includes biopsy.
$64.17
20610 describes needle aspiration and/or injection of a major joint. It does not describe an open tissue biopsy of the glenohumeral joint.
No office rate
23101 concerns arthrotomy with biopsy at the acromioclavicular or sternoclavicular joint, not the glenohumeral joint.
Compare 23100 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
Wisconsin →
Office / nonfacility
Unavailable
Facility
$451.17
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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 23100 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
2,163
- Code
- 23100
- Physician work
- 6.05
- Practice expense
- 7.37
- Malpractice
- 1.29
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.05 | × 1.000 | 6.0500 |
| Practice expense | 7.37 | × 0.958 | 7.0605 |
| Malpractice | 1.29 | × 0.308 | 0.3973 |
| Total RVUs | 13.5078 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wisconsin$451.17
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.05 | 1 |
| Practice expense | 7.37 | 0.958 |
| Malpractice | 1.29 | 0.308 |
(6.05 × 1 + 7.37 × 0.958 + 1.29 × 0.308) × $33.4009 = $451.17
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.
23100 billing questions
When is this code appropriate instead of a shoulder-joint aspiration?
Use this code for open tissue biopsy of the glenohumeral joint. A needle aspiration obtains joint fluid rather than tissue and may be reported with 20610 when that service is performed.
Does this code describe an arthroscopic biopsy?
No. It describes an open approach to the glenohumeral joint; document the surgical approach and tissue obtained.
How does this differ from the glenohumeral arthrotomy code for exploration?
This code is for an arthrotomy with biopsy. Code 23107 describes a different operative purpose involving exploration, drainage, or foreign-body removal.
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 bilateral performance handled?
When the procedure is performed bilaterally, modifier 50 applies, with payment at 150% under the CMS facts for this code.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeons are paid only with supporting documentation; 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.
2,16023076,,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
2,16323100,,Arthrotomy glenhumrl jt w/bx,A,,6.05,7.37,NA,7.37,,1.29,14.71,14.71,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,16423101,,Arthrt acrmclv/strnclav jt,A,,5.58,6.50,NA,6.50,,1.20,13.28,13.28,0,090,0.10,0.69,0.21,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,16523105,,Arthrotomy glenohumeral jt,A,,8.27,8.13,NA,8.13,,1.72,18.12,18.12,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,16623106,,Arthrotomy strnclav joint,A,,5.98,7.35,NA,7.35,,1.28,14.61,14.61,0,090,0.10,0.69,0.21,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,