CPT 23397 Multiple Muscle Transfer Reimbursement | OpenPayer

Summary & Overview

CPT 23397: Multiple Muscle Transfer to Shoulder/Upper Arm

CPT code 23397 represents a complex surgical muscle transfer procedure used to restore shoulder and upper-arm function after traumatic or degenerative muscle loss. The code captures transfer of multiple muscles from another body site to the shoulder or upper arm and is relevant to specialists in orthopedic trauma, reconstructive surgery, and peripheral nerve injury rehabilitation. Nationally, this service is important because it addresses significant functional impairment, can influence long-term disability outcomes, and often involves multidisciplinary care and substantial resource use. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical and billing overview, typical sites of service, and a baseline of common modifiers associated with reporting. The publication also outlines what stakeholders typically examine when managing coverage and reimbursement for complex reconstructive procedures: service definitions, surgical setting, and payer policy considerations. Data not available in the input will be explicitly noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 23397muscle transfershoulder reconstructionupper extremity surgeryorthopedic surgerysurgical billingambulatory surgical centerhospital inpatientreconstructive procedure

Billing Code Overview

CPT code 23397 describes a surgical procedure in which the provider transfers multiple muscles from another location on the patient’s body to the shoulder or upper arm. The procedure is performed to treat injuries that impair upper extremity function due to damage to muscles in the upper arm or shoulder.

Service type: Surgical, muscle transfer and reconstruction of the shoulder/upper arm
Typical site of service: Inpatient or outpatient hospital surgical setting, or ambulatory surgical center depending on clinical complexity and patient needs

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with significant loss of shoulder or upper arm muscle function after traumatic nerve injury, brachial plexus injury, or chronic sequelae of proximal humeral fracture with muscle avulsion. The patient presents with weakness or paralysis of shoulder abduction, external rotation, or elbow flexion that limits activities of daily living. Prior to surgery the clinical workflow includes history and physical exam, focused neurovascular and musculoskeletal testing, electromyography/nerve conduction studies, and imaging (MRI or ultrasound) to assess muscle viability and tendon integrity. The operative plan involves transfer of one or multiple donor muscles/tendons (for example latissimus dorsi, pectoralis major, or trapezius) to restore shoulder or upper arm function. The patient receives preoperative anesthesia evaluation, informed consent, and perioperative antibiotics; the procedure is performed in an operating room with general anesthesia and may involve intraoperative nerve monitoring. Postoperatively the patient begins immobilization followed by staged rehabilitation with physical and occupational therapy to retrain transferred muscles and optimize functional recovery. Typical site of service is an acute care hospital operating room or an ambulatory surgery center for selected cases requiring less complexity or comorbidity management.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or complexity substantially exceeds usual for the procedure, with documentation of reasons and extra work.

CPT 23400: Scapular Fixation for Shoulder Deformity

CPT-23440-BICEPS-TENDON-TENODESIS-SHOULDER-STABILIZATION

CPT 23440: Biceps Tenodesis for Shoulder Stabilization

CPT-23465-POSTERIOR-SHOULDER-CAPSULAR-REPAIR

CPT 23465: Posterior Shoulder Capsular Repair

CPT-23420-SHOULDER-RECONSTRUCTION-ACROMIOPLASTY

CPT 23420: Shoulder Reconstruction with Acromioplasty

CPT-23405-SHOULDER-TENOTOMY-TENDON-RELEASE

CPT 23405: Shoulder Tenotomy (Single Tendon, Small Incision)

CPT-23490-CLAVICLE-FIXATION-INTERNAL-FIXATION-CLAVICULAR-DEFECT

CPT 23490: Clavicle Fixation with Internal Implants

CPT-23466-SHOULDER-CAPSULE-REPAIR-MULTIDIRECTIONAL-INSTABILITY

CPT 23466: Shoulder Joint Capsule Repair for Multidirectional Instability

CPT-23412-OPEN-ROTATOR-CUFF-REPAIR-SHOULDER

CPT 23412: Open Surgical Repair of Chronic Rotator Cuff Tear

CPT-23470-SHOULDER-HEMIARTHROPLASTY-HUMERAL-HEAD-REPLACEMENT

CPT 23470: Shoulder Hemiarthroplasty, Humeral Head Replacement

CPT-23406-SHOULDER-MULTIPLE-TENOTOMY

CPT 23406: Multiple Tenotomy of Shoulder

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Taxonomy Code	Specialty	Notes
208100000X	Orthopaedic Surgery	Orthopedic surgeons commonly perform complex upper extremity muscle/tendon transfers.
207L00000X	Hand Surgery	Hand surgeons or upper extremity specialists frequently perform transfers to restore arm and shoulder function.
2080P0242X	Physical Medicine & Rehabilitation	PM&R physicians manage pre- and postoperative rehabilitation and functional assessment.
208000000X	General Surgery	General surgeons with reconstructive training may occasionally perform transfers in complex trauma centers.
207X00000X	Plastic Surgery	Plastic and reconstructive surgeons perform muscle transfers for restoration of form and function.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M62.81`	Muscle weakness (generalized)	Indicates significant muscle weakness that may prompt consideration of transfer to restore function.
`S14.10XA`	Injury of nerve root of neck, unspecified, initial encounter	Relevant for patients with nerve injuries causing upper extremity paralysis requiring muscle transfer.
`S44.01XA`	Injury of brachial plexus, unspecified, initial encounter	Brachial plexus injuries are a common indication for muscle or tendon transfer to restore shoulder/upper arm function.
`M75.1`	Rotator cuff tear or rupture, not specified as traumatic	Chronic rotator cuff deficiency with muscle loss may necessitate functional muscle transfer in complex reconstructions.
`G54.0`	Brachial plexus disorders	Neurologic disorders of the brachial plexus that result in loss of muscle function and potential need for transfer.
`S42.2XXA`	Fracture of the humerus, initial encounter for closed fracture	Proximal humerus fractures with muscle avulsion or persistent dysfunction can lead to reconstructive transfers.
`M21.64`	Contracture of elbow	Severe contracture limiting function may be treated with releases and muscle transfer as part of reconstructive strategy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`24350`	Transfer of coracoid process with coracobrachialis and short head of biceps for reconstruction of the shoulder	May be performed as a targeted tendon/muscle transfer for specific instability or reconstruction scenarios of the shoulder in the same operative setting.
`20550`	Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., ganglion)	May be performed preoperatively for diagnostic or therapeutic injection-based management prior to deciding on surgical transfer.
`29827`	Arthroscopy, shoulder, surgical; with rotator cuff repair	Often performed before or concomitantly if intra-articular pathology or rotator cuff repair is needed alongside muscle transfer.
`64718`	Neuroplasty and/or transposition; major peripheral nerve, arm or leg	May be performed when nerve repair or neurolysis is required in conjunction with tendon/muscle transfer for brachial plexus or nerve injury.
`97001`	Physical therapy evaluation	Represents the evaluation and therapy services used in the preoperative and postoperative rehabilitation plan following muscle transfer.

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