CPT 23450 Shoulder Capsular Repair Reimbursement | OpenPayer

Summary & Overview

CPT 23450: Shoulder Capsular Repair and Tightening

CPT code 23450 denotes surgical repair and tightening of the shoulder joint capsule (capsulorrhaphy) to treat tears and hyperlaxity that cause significant shoulder instability. This code captures a key orthopedic procedure used to restore shoulder stability after traumatic or recurrent dislocations and is widely relevant across surgical, rehabilitation, and payer policy contexts nationally. Payers commonly covering services tied to this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context about the procedure, typical sites of service, and the implications for coding and coverage decisions. The report outlines common billing considerations, applicable modifier usage patterns, and areas where policy updates or utilization controls often appear. It also highlights benchmarks for service setting and utilization, and summarizes topics that influence authorization and documentation requirements, such as indication for surgery and prior conservative management. Data not provided in the input — including specific ICD-10 pairings, associated taxonomies, payer-specific reimbursement rates, and related codes — are noted as unavailable. The content is intended to inform coding professionals, revenue cycle staff, and policy analysts about the clinical purpose and billing context of CPT code 23450 at a national level.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare23450CPTshoulder surgerycapsulorrhaphyorthopedic surgeryambulatory surgeryoperative procedureshoulder instabilitycoding

Billing Code Overview

CPT code 23450 describes a surgical repair of the shoulder joint capsule, addressing tears and tightening the capsule when hyperlaxity causes excessive or abnormal shoulder movement. The procedure is performed to treat severe shoulder instability and restore joint stability by repairing and imbricating the capsular tissue.

Service type: Surgical procedure — open or arthroscopic shoulder capsular repair and tightening (capsulorrhaphy).
Typical site of service: Operating room or ambulatory surgery center; inpatient setting when clinically indicated.

Clinical & Coding Specifications

Clinical Context

A 28-year-old male recreational athlete presents with recurrent anterior shoulder dislocations after a traumatic dislocation while playing rugby six months prior. He reports instability, subluxation episodes, and persistent pain and weakness despite conservative management including physical therapy and activity modification. Examination demonstrates positive apprehension and relocation tests and increased external rotation consistent with capsular laxity and labral injury. Imaging with MRI arthrogram confirms anteroinferior capsulolabral tear and redundant joint capsule.

The orthopedic surgeon schedules an open capsular shift/repair to tighten the joint capsule and repair the tear to restore stability. Preoperative workflow includes history and physical, informed consent, preoperative clearance, and anesthesia evaluation. Intraoperative steps include general anesthesia with possible regional block, diagnostic arthroscopy to evaluate intra-articular pathology, repair of the capsular tear with suture anchors and capsular plication (capsular shift), hemostasis, and closure. Postoperative workflow includes immediate recovery in PACU, pain control, immobilization in a sling, discharge instructions, and a rehabilitation plan with staged physical therapy focusing on protected range of motion and progressive strengthening over several months.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier listed (neutral)	Use when no specific modifier applies and the payer accepts unmodified code.

CPT 23412: Open Surgical Repair of Chronic Rotator Cuff Tear

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

CPT 23440: Biceps Tenodesis for Shoulder Stabilization

CPT-23472-TOTAL-SHOULDER-ARTHROPLASTY

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

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

CPT 23473: Revision Shoulder Arthroplasty with Prosthesis Exchange

CPT-23462-SHOULDER-CAPSULORRHAPHY-CORACOID-TRANSFER

CPT 23462: Shoulder Capsulorrhaphy with Coracoid Transfer

CPT-23415-CORACOACROMIAL-LIGAMENT-RELEASE-ACROMIOPLASTY

CPT 23415: Coracoacromial Ligament Release with Acromioplasty

CPT-23465-POSTERIOR-SHOULDER-CAPSULAR-REPAIR

CPT 23465: Posterior Shoulder Capsular Repair

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

CPT 23491: Proximal Humerus Fixation with Internal Implants

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

CPT 23455: Shoulder Capsular Repair with Labral Repair

CPT-23430-BICEPS-TENODESIS-PROXIMAL-HUMERUS

CPT 23430: Biceps Tenodesis to Proximal Humerus

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Taxonomy Code	Specialty	Notes
Data not available in the input.	Data not available in the input.	Data not available in the input.
207X00000X	Orthopaedic Surgery	Primary specialty performing shoulder capsular repair and capsular shift.
2084P0800X	Sports Medicine	Specialists who manage shoulder instability in athletes and perform operative repairs.
207L00000X	Hand Surgery (Upper Extremity)	Surgeons with focused practice in upper extremity/shoulder surgery who may perform this procedure.
2086S0102X	Physical Medicine & Rehabilitation	Providers involved in pre- and postoperative rehabilitation planning and functional recovery.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S43.011A`	Anterior dislocation of right shoulder, initial encounter	Common traumatic cause of capsular tear and instability leading to need for capsular repair.
`S43.012A`	Anterior dislocation of left shoulder, initial encounter	As above for the left shoulder; use appropriate laterality.
`M24.419`	Recurrent instability of right shoulder	Indicates chronic instability often treated with capsular repair/capsular shift like `23450`.
`M24.429`	Recurrent instability of left shoulder	Left-sided equivalent for coding recurrent instability.
`M75.11`	Traumatic rupture of the rotator cuff of right shoulder	May coexist with capsular tears; affects surgical planning if concurrent tendon repair required.
`M75.12`	Traumatic rupture of the rotator cuff of left shoulder	Left-sided equivalent.
`S43.002A`	Unspecified dislocation of right shoulder, initial encounter	Use when more specific dislocation type not documented; may lead to capsular injury.
`M75.81`	Other shoulder lesions (e.g., capsulitis not elsewhere classified)	Captures other shoulder pathology that may be addressed or evaluated during operative intervention.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`29806`	Arthroscopy, shoulder, surgical; capsulorrhaphy	Arthroscopic alternative to open capsular repair; may be performed instead of or in conjunction with `23450` if arthroscopic approach chosen.
`23350`	Capsulorrhaphy, shoulder; without repair of labrum (open)	Related open shoulder capsular procedure addressing instability; similar operative intent and technique.
`23455`	Capsulorrhaphy, shoulder; with repair of SLAP lesion	Used when superior labrum anterior-posterior repair is performed with capsular work; may be used when labral repair extends into superior labrum.
`29807`	Arthroscopy, shoulder, surgical; resection of distal clavicle including distal articular surface (Mumford procedure)	May be performed concomitantly if acromioclavicular pathology is addressed during same operative session.
`23220`	Open treatment of humeral head/neck fracture (e.g., ORIF)	May be performed in trauma cases where instability is associated with proximal humerus fracture requiring fixation; relevant in combined trauma workflows.

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