Summary & Overview
CPT 23400: Scapular Fixation for Shoulder Deformity
CPT code 23400 represents surgical fixation of the scapula to a rib or vertebra to correct shoulder asymmetry and restore function, commonly used for conditions such as Sprengel deformity. This reconstructive orthopedic procedure matters nationally because it addresses congenital or acquired scapular malposition that can significantly impair shoulder range of motion and quality of life, and it involves operative, perioperative, and rehabilitation resources.
Key payers in this coverage analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical intent of the code, typical sites of service, and the service type. The publication also highlights expected benchmarks and coverage considerations relevant to national payers, summarizes procedural context for coding and billing teams, and outlines areas where policy updates or utilization guidelines may affect reimbursement and prior authorization practices.
This summary provides clinicians, coding specialists, and policy analysts with the clinical context and payer scope needed to interpret CPT code 23400 in national billing and coverage discussions. Data not available in the input is noted where relevant in supporting sections.
Billing Code Overview
CPT code 23400 describes a surgical procedure in which the provider attaches the patient's scapula to a rib or vertebra to correct shoulder asymmetries or deformities that impair motion. This procedure is performed to address conditions such as Sprengel deformity, a congenital elevation of one scapula that can limit shoulder function and cause cosmetic asymmetry.
Service type: Surgical reconstruction of the shoulder girdle to reposition and stabilize the scapula.
Typical site of service: Hospital operating room or ambulatory surgical center for orthopedic/plastic reconstructive surgery.
Clinical & Coding Specifications
Clinical Context
A 9-year-old child with a congenital Sprengel deformity presents with a visibly elevated and malpositioned left scapula, limited shoulder abduction and external rotation, and progressive cosmetic concern and functional impairment. Preoperative workup includes clinical exam, radiographs, and CT scan to assess scapular position and omovertebral connections. The multidisciplinary workflow involves a pediatric orthopedic surgeon coordinating with anesthesia, intraoperative neurophysiologic monitoring when indicated, and perioperative nursing. The provider performs scapulothoracic fixation to lower and stabilize the scapula by attaching it to an adjacent rib or vertebra, correcting asymmetry and improving shoulder mechanics. Postoperative care includes immobilization, pain control, wound checks, physical therapy for gradual range-of-motion restoration, and follow-up imaging to confirm fixation and healing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard reporting | Use for routine reporting when no special modifier applies. |
22 | Increased procedural services | Use when the work required to perform is substantially greater than typically required (extensive deformity, prolonged dissection). |