CPT 23415 Coracoacromial Ligament Release Reimbursement | OpenPayer

Summary & Overview

CPT 23415: Coracoacromial Ligament Release with Acromioplasty

CPT code 23415 represents surgical release of the coracoacromial ligament, often combined with acromioplasty, to restore shoulder motion and relieve pain in patients with adhesive capsulitis, subacromial impingement, or a frozen shoulder. This procedure is clinically significant due to its role in addressing persistent shoulder dysfunction that does not respond to conservative care, and it is performed across hospital outpatient departments and ambulatory surgery centers nationwide.

Key payers in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, common billing modifiers, and which payers commonly reimburse or manage coverage for this service. The publication also summarizes benchmarks and policy considerations relevant to billing and coverage for surgical shoulder decompression procedures.

This summary is intended for coding and billing specialists, surgical providers, and policy analysts who need a clear, national-level understanding of CPT code 23415, its clinical purpose, and the payer landscape. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 23415shoulder surgeryacromioplastycoracoacromial ligament releaseorthopedic surgeryambulatory surgeryhospital outpatientsurgical procedureadhesive capsulitis

Billing Code Overview

CPT code 23415 describes a surgical procedure to release the coracoacromial ligament to restore shoulder function in patients with a stiff, painful, or frozen shoulder. The procedure may include acromioplasty, in which a portion of the undersurface of the acromion is shaved to relieve abnormal pressure on underlying muscle or tendon.

Service type: Open or arthroscopic shoulder surgical procedure for ligament release and decompression

Typical site of service: Hospital outpatient department or ambulatory surgery center, with possible inpatient care when clinically indicated.

Clinical & Coding Specifications

Clinical Context

A 58-year-old right-hand–dominant female presents with progressive right shoulder pain, decreased range of motion, and night pain for 9 months. Conservative management with physical therapy, oral NSAIDs, and intra-articular corticosteroid injection produced partial, transient relief. Examination shows limited active forward flexion and abduction with positive impingement signs and subacromial tenderness. Imaging (plain radiographs and MRI) demonstrates subacromial bursitis, acromial spurring, and thickening of the coracoacromial ligament consistent with impingement and adhesive capsulitis features. The orthopedic surgeon schedules arthroscopic release of the coracoacromial ligament with acromioplasty to decompress the subacromial space and improve shoulder motion and pain.

Typical clinical workflow:

Preoperative evaluation in the clinic with review of conservative treatments, imaging, and informed consent.
Pre-op clearance by primary care or medical medicine as indicated; anesthesia evaluation for general anesthesia with regional block.
Intraoperative procedure performed in an ambulatory surgery center or hospital operating room: arthroscopic coracoacromial ligament release with subacromial bursectomy and acromioplasty as indicated; documentation includes laterality, findings, and any additional procedures.
Postoperative recovery in PACU with neurovascular checks and pain control; discharge same day for ambulatory surgery center cases or next-day discharge if inpatient.
Postoperative instructions: sling protection brief period, early range-of-motion physical therapy, and scheduled follow-up for wound check and rehabilitation progression.

Coding Specifications

Related Codes

CPT-23406-SHOULDER-MULTIPLE-TENOTOMY

CPT 23406: Multiple Tenotomy of Shoulder

CPT-23455-SHOULDER-CAPSULAR-REPAIR-LABRAL-REPAIR

CPT 23455: Shoulder Capsular Repair with Labral Repair

CPT-23491-PROXIMAL-HUMERUS-FIXATION-IMPLANT-REPAIR

CPT 23491: Proximal Humerus Fixation with Internal Implants

CPT-23480-CLAVICLE-OSTEOTOMY-OPEN-CLAVICULAR-RECONSTRUCTION

CPT 23480: Clavicle Osteotomy or Open Clavicular Reconstruction

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

CPT 23466: Shoulder Joint Capsule Repair for Multidirectional Instability

CPT-23485-CLAVICLE-OSTEOTOMY-BONE-GRAFT-FIXATION

CPT 23485: Clavicle Osteotomy with Bone Graft and Fixation

CPT-23397-MULTIPLE-MUSCLE-TRANSFER-SHOULDER-UPPER-ARM-RECONSTRUCTION

CPT 23397: Multiple Muscle Transfer to Shoulder/Upper Arm

CPT-23450-SHOULDER-CAPSULAR-REPAIR-TIGHTENING

CPT 23450: Shoulder Capsular Repair and Tightening

CPT-23462-SHOULDER-CAPSULORRHAPHY-CORACOID-TRANSFER

CPT 23462: Shoulder Capsulorrhaphy with Coracoid Transfer

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

CPT 23470: Shoulder Hemiarthroplasty, Humeral Head Replacement

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Modifier	Description	When to Use
`RT`	Right side	Use when the procedure is performed on the right shoulder.
`LT`	Left side	Use when the procedure is performed on the left shoulder.
`50`	Bilateral procedure	Use when the procedure is performed on both shoulders during the same operative session per payer guidance.
`22`	Increased procedural services	Use when work, time, or technical difficulty substantially exceeds the usual for the procedure (document rationale).
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally planned.
`59`	Distinct procedural service	Use to indicate a separate, identifiable procedure not ordinarily reported with the primary code (support with operative note).
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of a complex case.
`78`	Unplanned return to OR for related procedure during global period	Use when a return to the OR for a related procedure occurs after the initial procedure.
`53`	Discontinued procedure	Use when the procedure is started but halted due to extenuating circumstances or patient condition.
`23`	Unusual anesthesia	Use when general anesthesia is not appropriate and an unusual anesthetic is required (per payer rules).

Taxonomy Code	Specialty	Notes
`207X00000X`	Orthopaedic Surgery	Primary specialty performing arthroscopic acromioplasty and coracoacromial ligament release.
`208000000X`	Physical Medicine & Rehabilitation	Often manages pre- and postoperative nonoperative care and rehab planning.
`207L00000X`	Sports Medicine (Orthopaedics)	Subspecialists who commonly treat impingement and perform arthroscopic decompression.
`207K00000X`	Hand Surgery (Orthopaedics)	May be listed when shoulder specialists have additional upper-extremity focus.
`363A00000X`	Anesthesiology	Provides general anesthesia and regional blocks for shoulder arthroscopy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M75.1`	Rotator cuff tear or rupture of shoulder, not specified as traumatic	Rotator cuff pathology commonly coexists with impingement and may be addressed during decompression.
`M75.4`	Impingement syndrome of shoulder	Primary indication for coracoacromial ligament release and acromioplasty to relieve mechanical impingement.
`M75.0`	Adhesive capsulitis of shoulder	Stiff shoulder (frozen shoulder) can coexist and influence surgical decision-making for release and mobilization.
`M75.3`	Calcific tendinitis of shoulder	May contribute to subacromial pain and be treated with debridement during arthroscopy.
`M75.2`	Bicipital tendinitis	Subacromial pathology often accompanies biceps tendon inflammation requiring concomitant management.
`M25.50`	Pain in joint, unspecified site	General shoulder pain diagnosis used when more specific code is not identified.
`S43.431A`	Sprain of right shoulder joint, initial encounter	Acute or subacute injuries leading to impingement or pain that may require surgical intervention.
`M19.011`	Primary osteoarthritis, right shoulder	Degenerative changes can create acromial spurs contributing to impingement and may prompt acromioplasty.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`29826`	Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament release	Commonly reported for arthroscopic acromioplasty and CA ligament release; may be used instead of an open code when arthroscopy performed.
`29822`	Arthroscopy, shoulder, surgical; debridement, limited	May be performed in conjunction for subacromial bursectomy or limited debridement during the same arthroscopic session.
`29823`	Arthroscopy, shoulder, surgical; debridement, extensive	Used when a more extensive debridement is required in addition to decompression.
`29807`	Arthroscopy, shoulder, surgical; capsulorrhaphy	May be performed in cases with instability or concomitant capsular pathology during the same operative setting.
`23350`	Repair, open, acute rotator cuff (does not include arthroscopic codes)	Related when rotator cuff repair is required; typically a separate or additional procedure and coding depends on approach and documentation.