CPT 23101 Acromioclavicular Debridement Reimbursement | OpenPayer

Summary & Overview

CPT 23101: Acromioclavicular/Sternoclavicular Joint Debridement or Biopsy

CPT code 23101 describes surgical incision of the acromioclavicular or sternoclavicular joint for removal of torn cartilage or for collection of tissue for laboratory diagnosis. This operative procedure is used to address joint pain and limited mobility arising from intra-articular pathology and may be performed in ambulatory surgery centers or hospital operating rooms. Nationally, accurate coding of procedures like 23101 affects surgical quality measurement, billing consistency, and appropriate claims adjudication for musculoskeletal specialty care.

Key payers in the national context include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for the code, typical sites of service, common billing considerations, and benchmarking information where available. The publication summarizes how 23101 is used in operative practice, outlines documentation elements that support the procedure’s clinical intent, and explains typical payer coverage patterns and claim adjudication topics relevant to this type of joint surgery.

This analysis is intended for clinicians, billing professionals, and policy analysts who need a concise briefing on the code’s clinical meaning, billing implications, and payer landscape at a national level. Data not available in the input is explicitly noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare23101CPTorthopedic-surgeryarthrotomybiopsyacromioclavicular-jointsternoclavicular-jointambulatory-surgery

Billing Code Overview

CPT code 23101 describes an operative procedure in which the clinician incises the acromioclavicular or sternoclavicular joint to remove torn cartilage or to obtain a tissue specimen for laboratory analysis. The service is intended to relieve pain and restore mobility in the affected clavicular joint and may include excision of damaged intra-articular tissue or biopsy for diagnostic purposes.

Service type: Surgical debridement/arthrotomy and biopsy of the clavicular joint
Typical site of service: Ambulatory surgery center or hospital operating room

Clinical & Coding Specifications

Clinical Context

A 48-year-old recreational tennis player presents with chronic lateral shoulder pain and limited overhead motion after a fall six months prior. Conservative care including physical therapy, nonsteroidal anti‑inflammatory drugs, and steroid injection provided limited relief. Physical examination reveals localized acromioclavicular joint point tenderness, reduced range of motion, and pain with cross‑body adduction. Imaging (plain radiographs and MRI) demonstrates acromioclavicular joint osteophytes and torn intra‑articular meniscal‑like disc tissue. The orthopedic surgeon schedules an outpatient procedure under regional anesthesia: incision of the acromioclavicular joint, debridement and removal of torn cartilage fragments, and selective biopsy of abnormal tissue for histopathology.

Clinical workflow:

Preoperative evaluation and imaging confirmation of AC joint pathology.
Informed consent documenting indication, risks, and planned debridement with possible biopsy.
Procedure performed in an ambulatory surgery center or hospital outpatient department; regional block with monitored anesthesia care or general anesthesia.
Surgical incision over the acromioclavicular joint, exposure, removal of torn cartilage/foreign tissue, and specimen submission to pathology if indicated.
Postoperative recovery with analgesia, sling as needed, and referral to physical therapy for range of motion and strengthening.

Coding Specifications

Modifier

CPT 23106: Sternoclavicular Joint Synovectomy

CPT-23184-PROXIMAL-HUMERUS-BONE-EXCISION-INFECTION

CPT 23184: Excision of Infected Bone, Proximal Humerus

CPT-23190-SCAPULAR-PARTIAL-RESECTION-SHOULDER-BLADE-EXCISION

CPT 23190: Partial Resection of Scapula for Infection or Tumor

CPT-23210-RADICAL-SCAPULA-TUMOR-RESECTION

CPT 23210: Radical Resection of Tumor, Scapula

CPT-23105-SHOULDER-SYNOVECTOMY-OPEN-ARTHROTOMY

CPT 23105: Open Shoulder Synovectomy with Synovial Excision

CPT-23130-ACROMION-RESHAPING-ACROMIOPLASTY-SHOULDER-DECOMPRESSION

CPT 23130: Acromion Reshaping (Acromioplasty) for Shoulder Decompression

CPT-23078-EXTENSIVE-EXCISION-SHOULDER-SOFT-TISSUE-SARCOMA-5CM-PLUS

CPT 23078: Extensive Excision of Shoulder Soft Tissue Malignant Tumor

CPT-23075-EXCISION-SUBCUTANEOUS-SHOULDER-MASS-LESS-THAN-3CM

CPT 23075: Excision of Subcutaneous Shoulder Mass, Specimen < 3 cm

CPT-23155-HUMERUS-CYST-EXCISION-WITH-BONE-GRAFT

CPT 23155: Humerus Cyst Excision with Autologous Bone Graft

CPT-23076-SHOULDER-INTRAMUSCULAR-MASS-EXCISION-LESS-THAN-5CM

CPT 23076: Excision of Intramuscular Shoulder Mass, <5 cm

Showing 1–10 of 32

Taxonomy Code	Specialty	Notes
`207P00000X`	Orthopaedic Surgery	Primary specialty performing AC joint debridement and biopsy.
`207L00000X`	Hand Surgery (Orthopedic)	Orthopaedists with hand/upper extremity focus may perform this procedure.
`208000000X`	General Surgery	General surgeons occasionally perform shoulder procedures in specific settings.
`207K00000X`	Sports Medicine	Orthopaedic sports medicine specialists commonly perform this procedure.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M19.011`	Primary osteoarthritis, right shoulder	AC joint osteoarthritic changes causing pain and requiring debridement.
`M19.012`	Primary osteoarthritis, left shoulder	Same as above for left side.
`M75.11`	Adhesive capsulitis of right shoulder	May coexist with AC joint pathology and contribute to stiffness; often addressed in postoperative therapy.
`M75.12`	Adhesive capsulitis of left shoulder	As above for left side.
`S43.011A`	Superior glenohumeral joint dislocation, right shoulder, initial encounter	Traumatic injuries that can produce AC joint damage and torn intra‑articular cartilage.
`S43.012A`	Superior glenohumeral joint dislocation, left shoulder, initial encounter	As above for left side.
`M75.91`	Unspecified shoulder lesion, right shoulder	Non‑specific shoulder pathology where diagnostic debridement/biopsy may be indicated.
`M75.92`	Unspecified shoulder lesion, left shoulder	As above for left side.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`23120`	Excision, osteophyte(s) and/or distal clavicle for acromioclavicular joint disease	Performed when distal clavicle resection is required for AC joint arthrosis beyond simple debridement.
`29826`	Arthroscopy, shoulder, distal claviculectomy including arthroscopic debridement	Arthroscopic alternative to open debridement; may be performed instead of or in conjunction with debridement.
`99223`	Initial hospital care, typically 70 minutes or more	Preoperative inpatient evaluation when patient is admitted for same‑day or inpatient surgery.
`11042`	Debridement, subcutaneous tissue and fascia	Adjunct debridement codes if extensive soft tissue debridement is performed.
`88305`	Surgical pathology, gross and microscopic examination	Used to bill the pathology evaluation of submitted biopsy specimens from the AC joint.

`51`	Multiple procedures	When other distinct procedures are billed on the same day in addition to this procedure.
`52`	Reduced services	When the procedure is partially reduced or not completed as described.
`53`	Discontinued procedure	When the procedure is started but halted due to extenuating circumstances.
`59`	Distinct procedural service	To indicate a separate, distinct procedure from other services on the same date.
`62`	Two surgeons	When two surgeons work together as primary surgeons performing separate portions.
`66`	Surgical team	When services are performed by a surgical team model.
`76`	Repeat procedure by same physician	When the same physician repeats the procedure within the postoperative period (Note: `76` not in provided list; excluded).
`78`	Return to operating room for a related procedure during the postoperative period	When an unplanned return to the OR for a related procedure occurs during global period.
`80`	Assistant surgeon	When an assistant surgeon participates in the procedure.
`81`	Minimum assistant surgeon	When minimal assistance is provided and billed accordingly.
`22`	Increased procedural services	When work required to perform the procedure is substantially greater than usual.
`26`	Professional component	When only the professional interpretation component is reported (rare for this code).
`TC`	Technical component	When only the technical component is billed (rare for this procedure).

OpenPayer