CPT 23130 Acromioplasty Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 23130: Acromion Reshaping (Acromioplasty) for Shoulder Decompression

CPT code 23130 represents surgical reshaping of the acromion (acromioplasty) to decompress the subacromial space, restore shoulder motion, and protect the rotator cuff. The procedure is commonly performed for subacromial impingement, rotator cuff pathology prevention, and to relieve pain and mechanical restriction. Nationally, acromioplasty remains a frequently billed orthopedic shoulder procedure with implications for surgical utilization, cost of care, and outcomes for patients with shoulder impingement.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical context for the procedure, typical sites of care (hospital outpatient, ambulatory surgery center, inpatient when indicated), and a summary of common billing elements associated with the service. The publication outlines benchmarks and coverage considerations where available, highlights coding and billing nuances tied to procedural description, and summarizes policy updates or payer guidance when present.

This analysis is written for a national audience and focuses on what CPT code 23130 represents, why it matters in surgical care and billing, and what stakeholders can expect when reviewing claims, coverage, or utilization related to this shoulder decompression procedure.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare23130CPTacromioplastyshoulder surgeryorthopedicssurgical procedureoutpatient surgerybilling

Billing Code Overview

CPT code 23130 describes a procedure to reshape the acromion, the bony projection at the end of the shoulder blade, to restore shoulder motion and protect the rotator cuff. The provider may partially remove the acromion and/or incise the ligament that attaches to the shoulder blade muscle to relieve impingement and improve function.

Service type: Open or arthroscopic acromioplasty / acromion reshaping (surgical procedure to decompress the subacromial space)
Typical site of service: Hospital outpatient department, ambulatory surgery center, or inpatient hospital surgical setting depending on clinical context and patient needs

Data not available in the input for associated taxonomies and ICD-10 diagnoses.

Clinical & Coding Specifications

Clinical Context

A 52-year-old recreational athlete presents with progressive anterolateral shoulder pain, weakness with overhead activities, and impaired range of motion despite 3 months of conservative care including physical therapy and NSAIDs. Imaging with shoulder radiographs and MRI demonstrates acromial spurring and compression of the subacromial space with rotator cuff impingement without full-thickness tear. The orthopedic surgeon schedules an open or arthroscopic subacromial decompression with acromioplasty to restore the subacromial space and reduce impingement.

Preoperative workflow includes history and physical, review of imaging, informed consent documenting indications and planned acromioplasty, pre-op anesthesia evaluation, and surgical consent for 23130. The procedure is typically performed in an ambulatory surgery center or hospital operating room under regional or general anesthesia with possible local infiltration. Postoperative workflow includes recovery room monitoring, discharge instructions, pain control plan, and scheduled outpatient physical therapy for progressive range-of-motion and strengthening.

Coding Specifications

Modifier	Description	When to Use
`51`	Multiple procedures	When `23130` is billed with other distinct procedures on the same day by the same provider.

CPT 23172: Excision of Sequestrum From Scapula

CPT-23125-CLAVICLE-EXCISION-COLLARBONE-RESECTION

CPT 23125: Clavicle (Collarbone) Excision

CPT-23195-PROXIMAL-HUMERUS-RESECTION-HUMERAL-HEAD-REMOVAL

CPT 23195: Resection of Proximal Humeral Head for Infection or Tumor

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

CPT 23184: Excision of Infected Bone, Proximal Humerus

CPT-23220-PROXIMAL-HUMERUS-TUMOR-RESECTION

CPT 23220: Radical Resection of Tumor, Proximal Humerus

CPT-23066-SHOULDER-DEEP-SOFT-TISSUE-EXCISIONAL-BIOPSY

CPT 23066: Excisional Biopsy of Deep Soft Tissue, Shoulder

CPT-23156-PROXIMAL-HUMERUS-CYST-CURETTAGE-BONE-GRAFT

CPT 23156: Excision/Curettage of Proximal Humerus Cyst with Bone Graft

CPT-23210-RADICAL-SCAPULA-TUMOR-RESECTION

CPT 23210: Radical Resection of Tumor, Scapula

CPT-23170-CLAVICLE-SEQUESTRUM-EXCISION

CPT 23170: Excision of Clavicle Sequestrum

CPT-23077-EXTENSIVE-EXCISION-SHOULDER-SOFT-TISSUE-SARCOMA-LESS-5CM

CPT 23077: Extensive Excision of Malignant Soft Tissue Tumor, Shoulder

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Taxonomy Code	Specialty	Notes
`207X00000X`	Orthopaedic Surgery	Most common specialty performing `23130`.
`207L00000X`	Sports Medicine (Orthopaedics)	Frequently performs arthroscopic or open acromioplasty for athletes.
`2084P0800X`	Physical Medicine & Rehabilitation	May manage pre- and postoperative nonoperative care and refer for surgery.
`363A00000X`	Anesthesiology	Provides regional or general anesthesia for the procedure.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M75.11`	Bursitis of right shoulder	Subacromial bursitis commonly causes impingement treated with acromioplasty.
`M75.12`	Bursitis of left shoulder	Contralateral presentation; relevant when side-specific coding is required.
`M75.41`	Impingement syndrome of right shoulder	Primary indication for acromioplasty to relieve impingement.
`M75.42`	Impingement syndrome of left shoulder	Same as above for left side.
`M75.101`	Unspecified rotator cuff tear or rupture of right shoulder, not specified as traumatic	Partial cuff pathology with impingement may be addressed concurrently.
`M75.102`	Unspecified rotator cuff tear or rupture of left shoulder, not specified as traumatic	Same as above for left side.
`M19.011`	Primary osteoarthritis, right shoulder	Degenerative acromial spurring contributing to impingement and pain.
`M19.012`	Primary osteoarthritis, left shoulder	Same as above for left side.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`29826`	Arthroscopy, shoulder, surgical; distal claviculectomy including partial resection of the distal clavicle, when performed	May be performed concurrently if acromioclavicular joint pathology is present.
`29827`	Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, when performed arthroscopically	Arthroscopic equivalent often reported instead of open `23130` when procedure is performed via arthroscopy.
`23410`	Tenodesis of long head of biceps tendon	May be performed in same setting if biceps pathology contributes to shoulder pain.
`29822`	Arthroscopy, shoulder, surgical; debridement, limited	Often performed in conjunction to address rotator cuff fraying or bursal debridement during subacromial decompression.
`73030`	Radiologic examination, shoulder; complete, minimum of 2 views	Preoperative or postoperative imaging commonly obtained to evaluate acromial morphology and hardware if used.
`99100`	Anesthesia for patient of extreme age, under 1 year or over 70 years, requiring more intensive monitoring	Potentially applicable to specific patient populations requiring additional anesthesia resources.

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