Summary & Overview
CPT 23410: Open Surgical Repair of Acute Rotator Cuff Tear
CPT code 23410 represents an open surgical repair of an acute rotator cuff tear of the shoulder, a definitive operative treatment for tendon avulsions or full-thickness tears that compromise shoulder function. This code is clinically significant nationwide because rotator cuff injuries are common and surgical repair affects resource use, surgical scheduling, and reimbursement for orthopaedic services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the service, typical sites of care, and the types of information payers commonly evaluate for coverage and claims adjudication. The publication summarizes benchmarks and utilization patterns, highlights any recent policy updates affecting coverage and prior authorization, and provides coding and billing considerations relevant to surgical and facility stakeholders.
The content is intended to inform clinicians, billing professionals, and policy analysts about how CPT code 23410 is used in practice, what to expect in terms of site-of-service delivery, and the payer landscape that influences authorization and reimbursement processes. Data not provided in the input are noted where applicable.
Billing Code Overview
CPT code 23410 describes an open surgical repair of an acute rotator cuff tear in the shoulder. The procedure involves direct visualization and repair of one or more torn rotator cuff tendons to restore shoulder stability and function.
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Service type: Open surgical orthopaedic procedure
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Typical site of service: Hospital operating room or ambulatory surgery center
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Clinical & Coding Specifications
Clinical Context
A 56-year-old right-hand dominant patient presents to an orthopedic clinic after an acute fall onto an outstretched arm with immediate shoulder pain, weakness with overhead activity, and an inability to lift the arm. Physical exam demonstrates positive supraspinatus testing and visible weakness of the rotator cuff. MRI of the shoulder confirms a full-thickness tear of the supraspinatus tendon with tendon retraction and surrounding edema. The patient is scheduled for an open surgical rotator cuff repair.
Preoperative workflow includes informed consent, medical clearance, and preoperative imaging review. On the day of surgery the patient undergoes general anesthesia (often with an interscalene nerve block for postoperative analgesia). In the operating room the surgeon performs an open repair of the torn rotator cuff tendon(s) through a deltoid-splitting or deltoid-detaching approach, achieves tendon-to-bone fixation with suture anchors or transosseous sutures, achieves hemostasis, and closes in layers. Postoperative workflow includes immediate recovery monitoring, pain management, immobilization in a sling, initiation of physical therapy per protocol, and follow-up visits for wound check and staged rehabilitation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or technical difficulty substantially exceeds typical rotator cuff repair (document additional work). |