CPT 23430 Biceps Tenodesis Reimbursement | OpenPayer

Summary & Overview

CPT 23430: Biceps Tenodesis to Proximal Humerus

CPT code 23430 denotes surgical tenodesis of the long head of the biceps tendon, a procedure that removes a damaged tendon fragment and secures the tendon to the proximal humerus to restore shoulder stability and function. This code is nationally relevant because biceps tendon pathology and related shoulder dysfunction are common contributors to pain, loss of function, and surgical demand among adults; accurate coding affects clinical documentation, surgical quality reporting, and reimbursement consistency. Key payers discussed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn clinical context for use of the code, typical sites of service, and common modifiers associated with surgical procedures when available. The publication provides benchmarking and payment context where data exists, summarizes relevant policy updates impacting coverage or prior authorization practices, and outlines coding considerations that affect claim submission and medical record alignment. Data not available in the input is noted where applicable; the focus remains on national implications for providers, payers, and revenue cycle teams.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 23430biceps tenodesisshoulder surgeryorthopedicssurgical procedureoutpatient surgeryrevenue cycleprocedure coding

Billing Code Overview

CPT code 23430 describes a surgical procedure in which the provider performs tenodesis of the long head of the biceps tendon: the surgeon removes the damaged fragment of the tendon and secures the tendon to the proximal humerus to restore stability and function. This procedure is indicated for patients with severe long head biceps tendon injury resulting from recurrent shoulder impingement, degenerative shoulder changes, or traumatic tendon damage.

Service type: Surgical tendon repair/tenodesis of the long head of the biceps
Typical site of service: Hospital outpatient surgical department or ambulatory surgery center

Clinical & Coding Specifications

Clinical Context

A 56-year-old right-hand–dominant male presents with chronic anterior shoulder pain, weakness with elbow flexion, and mechanical clicking after years of recurrent subacromial impingement and progressive biceps tendon degeneration. Conservative care including physical therapy, anti-inflammatory medication, and corticosteroid injection provided temporary relief but symptoms progressed with persistent pain and functional loss affecting work and activities of daily living. Imaging (MRI) demonstrates a partial-to-full thickness tear and tendinopathy of the long head of the biceps tendon with associated superior labrum fraying.

The orthopaedic surgeon evaluates shoulder range of motion, strength, and provocative tests (Speed, Yergason). After shared decision-making, the surgeon schedules a surgical biceps tenodesis (CPT 23430) to remove the damaged intra-articular fragment of the long head of the biceps and fix the tendon to the proximal humerus. Typical workflow: preoperative assessment and clearance, informed consent, regional block or general anesthesia, open or arthroscopic-assisted tenodesis in the operating room or ambulatory surgery center, intraoperative documentation of tendon pathology and fixation method, postoperative recovery and outpatient physical therapy for progressive range-of-motion and strengthening.

Typical site of service: Ambulatory Surgery Center or Hospital Outpatient Surgery depending on patient comorbidities and facility capabilities. Service type: Surgical – Orthopaedic shoulder procedure (biceps tenodesis).

Coding Specifications

Modifier	Description

CPT 23480: Clavicle Osteotomy or Open Clavicular Reconstruction

CPT-23474-SHOULDER-REVISION-ARTHROPLASTY-GLENOID-HUMERAL-REVISION

CPT 23474: Revision Arthroplasty of Shoulder, Glenoid and Humeral Components

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

CPT 23455: Shoulder Capsular Repair with Labral Repair

CPT-23405-SHOULDER-TENOTOMY-TENDON-RELEASE

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

CPT-23472-TOTAL-SHOULDER-ARTHROPLASTY

CPT 23472: Total Shoulder Arthroplasty, Humeral Head and Glenoid Replacement

CPT-23395-MUSCLE-TRANSFER-SHOULDER-UPPER-ARM-RECONSTRUCTION

CPT 23395: Muscle Transfer to Shoulder or Upper Arm

CPT-23450-SHOULDER-CAPSULAR-REPAIR-TIGHTENING

CPT 23450: Shoulder Capsular Repair and Tightening

CPT-23420-SHOULDER-RECONSTRUCTION-ACROMIOPLASTY

CPT 23420: Shoulder Reconstruction with Acromioplasty

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

CPT 23440: Biceps Tenodesis for Shoulder Stabilization

CPT-23473-REVISION-SHOULDER-ARTHROPLASTY-PROSTHESIS-EXCHANGE

CPT 23473: Revision Shoulder Arthroplasty with Prosthesis Exchange

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`26`	Professional component	Use when billing only the surgeon’s professional component separate from a technical facility component (rare for this global surgical CPT).
`50`	Bilateral procedure	Use when the biceps tenodesis is performed on both shoulders during the same operative session.
`52`	Reduced services	Use if the procedure is started but not completed as planned and a reduced service is documented.
`53`	Discontinued procedure	Use if the procedure is terminated due to extenuating circumstances after anesthesia induction and documentation supports discontinuation.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the procedure.
`66`	Surgical team	Use when multiple surgeons from a surgical team participate and billing under a team arrangement is appropriate.
`59`	Distinct procedural service	Use to indicate a separate and distinct procedure or service performed on the same day that is not normally reported together.
`76`	Repeat procedure by same physician	Use when the same physician performs the same procedure later the same day (if clinically necessary).
`77`	Repeat procedure by another physician	Use when a different physician repeats the same procedure later the same day.
`78`	Return to the operating room for a related procedure during the postoperative period	Use when the patient returns to the OR for a complication related to the initial tenodesis during the global postoperative period.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated procedure is performed during the global period.
`22`	Increased procedural service	Use when work performed is substantially greater than typically required and documentation supports unusual complexity.
`52`	Reduced services	(listed to emphasize applicability for intraoperative decision to limit procedure)
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	Use for preoperative or postoperative telemedicine visits when performed and billed per payer rules.

Taxonomy Code	Specialty	Notes
207X00000X	Orthopaedic Surgery	Primary specialty performing `CPT 23430`; shoulder-focused orthopaedists commonly perform tenodesis.
207L00000X	Sports Medicine (Orthopaedic)	Surgeons with sports medicine subspecialty frequently manage biceps pathology.
2080S0122X	Physical Medicine & Rehabilitation	May provide perioperative nonoperative management and postoperative rehabilitation planning.
363L00000X	Anesthesiology	Regional or general anesthesia services for the operative procedure.
208600000X	Physical Therapist	Provides postoperative rehabilitation; included as common ancillary provider in the clinical workflow.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M75.81`	Other shoulder lesions, right shoulder	Common code for right-sided biceps/shoulder pathology when a specific code is not selected; aligns with symptomatic biceps tendon disease.
`M75.82`	Other shoulder lesions, left shoulder	Common code for left-sided biceps/shoulder pathology for laterality-specific reporting.
`M75.1`	Rotator cuff tear or rupture, not specified as traumatic	Frequently coexists with long head of biceps tendon pathology and may be addressed during shoulder surgery.
`S43.431A`	Sprain of right shoulder joint, initial encounter	Used when acute traumatic injury to the shoulder leads to biceps tendon damage requiring tenodesis.
`M67.81`	Other synovitis and tenosynovitis, shoulder region	Reflects inflammatory degenerative conditions affecting the biceps tendon relevant to tenodesis.
`M24.21`	Disorder of ligament, right shoulder	Indicates chronic instability or degenerative changes contributing to biceps tendon pathology and the decision for tenodesis.
`M19.011`	Primary osteoarthritis, right shoulder	Degenerative shoulder disease that can be associated with biceps tendon degeneration necessitating tenodesis.
`S46.011A`	Strain of muscle(s) and tendon of the long head of biceps, right arm, initial encounter	Specific acute tendon injury diagnosis for cases where tenodesis is performed for repair after acute strain/tear.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`29827`	Arthroscopy, shoulder, surgical; biceps tenodesis	Arthroscopic approach to biceps tenodesis often billed when the tenodesis is performed arthroscopically rather than open; may be used when fixation is done arthroscopically.
`23410`	Tenotomy, biceps tendon (eg, open; release of long head of biceps tendon)	Performed when simple release/tenotomy is chosen instead of tenodesis; may be an alternative or intraoperative decision.
`29826`	Arthroscopy, shoulder, surgical; biceps tenotomy	Arthroscopic release of the long head of the biceps tendon; may be performed in conjunction with other arthroscopic shoulder procedures.
`29822`	Arthroscopy, shoulder, surgical; debridement, limited	Often performed concurrently to address intra-articular fraying, labral debridement, or synovitis seen during tenodesis.
`29824`	Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface	May be performed in patients with coexisting acromioclavicular joint pathology during the same anesthetic.
`29848`	Arthroscopy, shoulder, surgical; distal clavicle excision, includes Mumford procedure	Alternative code describing distal clavicle procedures when combined shoulder pathology is treated in the same setting.

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