Summary & Overview
CPT 23405: Shoulder Tenotomy (Single Tendon, Small Incision)
CPT code 23405 represents a surgical tenotomy of a single tendon in the shoulder performed through a small skin incision to treat painful congenital or acquired shoulder conditions. Nationally, this code is used to document a focused shoulder soft-tissue procedure that can be performed in ambulatory surgical centers or hospital outpatient departments, and it has implications for surgical care pathways, billing integrity, and payer coverage policies for musculoskeletal procedures.
Key payers in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the procedure, common sites of service, and the payer landscape relevant to claims and coverage determinations. The publication also summarizes typical billing considerations, common modifiers encountered with this code, and related coding practices affecting reimbursement and compliance.
This summary serves clinicians, coding professionals, and policy analysts who need a concise reference for the clinical meaning of CPT code 23405, the settings in which it is typically performed, and the payer environment that commonly adjudicates these services. Data not provided in the input (such as associated taxonomies, ICD-10 pairings, or detailed payer-specific rules) are noted where applicable in the full publication.
Billing Code Overview
CPT code 23405 describes a shoulder tenotomy procedure in which a single tendon is incised or divided through a small skin incision to correct painful shoulder conditions arising from congenital or acquired causes. The procedure is a focused soft-tissue surgical intervention on the shoulder designed to relieve tendon-related pain and restore function.
Service type: Surgical — tendon release/tenotomy of the shoulder
Typical site of service: Hospital outpatient department or ambulatory surgical center, depending on clinical context and facility capabilities.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient presents with chronic lateral shoulder pain and restricted range of motion after failed conservative management including physical therapy, corticosteroid injections, and NSAIDs. Examination and imaging identify a symptomatic partial-thickness tear and persistent tendinous impingement of the long head of the biceps tendon causing activity-limiting pain. The orthopedic surgeon discusses options and elects to perform an open or limited incision tenotomy of a single tendon in the shoulder under regional or general anesthesia.
The clinical workflow: preoperative evaluation and informed consent in the clinic; preop anesthesia assessment; operative time in an ambulatory surgery center or hospital outpatient department; a small incision is made, the affected tendon is incised/divided (single-tendon tenotomy), hemostasis obtained, and wound closed. Postoperative recovery includes short observation, discharge with analgesia and sling, and scheduled follow-up for wound check and rehabilitation planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the surgeon's professional service separate from technical facility charges |
50 |