Summary & Overview
CPT 23071: Excision of Shoulder Soft-Tissue Mass, ≥3 cm
CPT code 23071 represents surgical excision of a soft-tissue mass or tumor located immediately under the skin of the shoulder, with the specimen size documented as 3 cm or greater. This code is used to report definitive removal of subcutaneous shoulder masses and the submission of the specimen for pathologic analysis. Nationally, accurate use of this code matters for clinical documentation, surgical coding consistency, and appropriate payment for procedures that require more extensive dissection and specimen handling.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and common billing considerations relevant to hospital outpatient departments and ambulatory surgery centers. The publication outlines benchmarks and coding guidance to assist coding professionals and revenue cycle staff in recognizing when the 3 cm size threshold applies and how that affects procedural reporting. It also highlights policy updates and payer coverage considerations that commonly influence claim adjudication for soft-tissue excisions in the shoulder.
This national overview is intended for coding professionals, surgical teams, and billing analysts seeking a clear summary of the clinical intent and billing implications of CPT code 23071. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 23071 describes excision of an abnormal soft-tissue mass or tumor located immediately beneath the skin in the shoulder, with the submitted specimen measuring 3 cm or greater. The procedure involves removal of the lesion and submission of the tissue to a laboratory for analysis and diagnosis.
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Service type: Surgical excision of soft-tissue mass (major excision)
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Typical site of service: Ambulatory surgery center or hospital outpatient department (procedure performed at the shoulder soft-tissue site)
Clinical & Coding Specifications
Clinical Context
A 52-year-old male presents to the orthopedic clinic with a slowly enlarging, palpable mass over the lateral aspect of the right shoulder. The mass is mobile, subcutaneous, approximately 4.0 cm by history and ultrasound measurement, mildly tender, and has grown over several months. The provider performs pre-operative evaluation, obtains informed consent, documents lesion size and location, and schedules an excision in an outpatient ambulatory surgery center. On the day of service the patient receives local or monitored anesthesia care; the surgeon incises through skin and subcutaneous tissue, dissects to the abnormal soft tissue mass in the shoulder region, removes the lesion intact, and sends the specimen measuring ≥3.0 cm to surgical pathology for histologic analysis. Hemostasis is achieved, the wound is irrigated and closed, and the patient is discharged with routine post-operative instructions.
Common clinical workflow steps include preoperative history and physical, imaging confirmation (e.g., ultrasound), procedural consent, lesion excision with specimen submission to pathology, operative note documentation including size and location, anesthesia documentation, and post-operative follow-up for wound check and pathology review.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician’s professional work distinct from the technical component (rare for excisions but applicable if separate technical services billed by facility). |