Summary & Overview
CPT 23105: Open Shoulder Synovectomy with Synovial Excision
CPT code 23105 denotes an open synovectomy of the shoulder: an incision into the shoulder joint to inspect and excise inflamed synovial tissue, with optional biopsy for laboratory analysis. This procedure is clinically important for patients with synovial inflammation causing pain and limited motion and can be performed in inpatient or outpatient surgical settings. Nationally, billing and coverage patterns for open shoulder synovectomy influence surgical access and cost for musculoskeletal care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find concise clinical context for the procedure, an overview of typical sites of service, and the procedural scope captured by the code. The publication also presents payer coverage considerations and benchmark comparisons where available, highlights common billing modifiers used with this code, and summarizes documentation and coding points relevant to accurate claim submission.
This summary is intended for healthcare administrators, coding professionals, and policy analysts seeking a national overview of CPT code 23105, its clinical application, and the billing context that affects reimbursement and utilization monitoring.
Billing Code Overview
CPT code 23105 describes an open surgical procedure in which the provider makes an incision into the shoulder joint to inspect and repair the synovium, the membrane that lines the bony surfaces of the joint. The procedure includes excision of inflamed synovial tissue to relieve pain and restore range of motion. When indicated, a tissue sample is taken and submitted for laboratory analysis to aid diagnosis.
Service type: Open synovectomy of the shoulder; diagnostic and therapeutic arthrotomy with synovial excision.
Typical site of service: Hospital operating room or outpatient surgical center (ambulatory surgery center) where open shoulder joint procedures are performed.
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient presents with progressive left shoulder pain, morning stiffness, and limited range of motion after months of conservative management including physical therapy and corticosteroid injections. Imaging (MRI) shows marked synovial hypertrophy and joint effusion consistent with inflammatory synovitis. The orthopedic surgeon schedules an open shoulder synovectomy to excise inflamed synovial tissue, inspect intra-articular structures, and obtain synovial biopsy for histopathology and culture.
Typical clinical workflow:
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Preoperative evaluation and clearance with documented indication of symptomatic synovitis and failed conservative care.
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Informed consent specifically describing incision of the shoulder joint, excision of synovium, possible biopsy, and potential conversion to a more extensive procedure if additional pathology is found.
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Operative procedure in an ambulatory surgery center or hospital operating room under regional block with sedation or general anesthesia.
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Intraoperative inspection of the glenohumeral joint, excision of inflamed synovial tissue, hemostasis, and submission of tissue specimens to pathology/microbiology as indicated.
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Postoperative recovery with analgesia, wound care instructions, and a plan for physical therapy to restore motion.
Typical site of service: Hospital outpatient department or Ambulatory Surgery Center (ASC) depending on patient comorbidities and facility capabilities.
Service type: Surgical — Open shoulder synovectomy with diagnostic biopsy as indicated.