CPT 23455 Shoulder Capsular Repair Reimbursement | OpenPayer

Summary & Overview

CPT 23455: Shoulder Capsular Repair with Labral Repair

CPT code 23455 represents surgical repair of the shoulder joint capsule with capsular tightening for hyperlaxity and often includes labral repair (for example, a Bankart-type repair). This procedure addresses severe shoulder instability that can cause recurrent dislocation or functional impairment, making it clinically significant across orthopedic and sports medicine practices nationwide. Key payers considered in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the clinical context for use of CPT code 23455, the typical settings where the procedure is performed, and the payer landscape relevant to claims processing. The publication also summarizes common billing considerations, associated service lines, and related procedure groupings to inform coding consistency and administrative workflows. Content is intended for coding professionals, billing managers, and clinical leaders seeking a concise overview of the code’s purpose, service environment, and payer coverage scope. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare23455CPTshoulder-surgerycapsular-repairlabral-repairorthopedicssurgical-procedureambulatory-surgeryshoulder-instability

Billing Code Overview

CPT code 23455 describes a surgical procedure to repair a tear in the shoulder joint capsule and to tighten the capsule when hyperlaxity (excessive, abnormal shoulder movement) contributes to instability. The procedure commonly includes repair of an associated labral tear, as performed in procedures such as a Bankart repair.

Service type: Shoulder capsular repair with tightening and labral repair (surgical, orthopedic procedure)
Typical site of service: Hospital outpatient surgery center or inpatient operating room

Clinical & Coding Specifications

Clinical Context

A 26-year-old male recreational athlete presents with recurrent right shoulder dislocations after a traumatic anterior shoulder injury while playing soccer six months prior. He reports persistent pain, a feeling of instability with overhead activity, and failed conservative management including physical therapy and activity modification. Imaging (MRI) demonstrates an anterior labral tear consistent with a Bankart lesion and capsular laxity. The orthopedic surgeon schedules an arthroscopic capsular repair with labral fixation to restore stability and tighten the joint capsule.

The clinical workflow includes preoperative evaluation with history and physical exam focused on shoulder stability tests, preoperative imaging review (MRI or MR arthrogram), informed consent, same-day operative arthroscopy under general anesthesia with possible regional block, arthroscopic Bankart repair with capsular plication using suture anchors, intraoperative documentation of anchors and implants, immediate postoperative neurovascular check, discharge with sling and postoperative rehabilitation plan, and routine follow-up visits to evaluate healing and range of motion.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the surgeon's professional service separate from the technical facility component (rare for operative procedures but used for associated physician professional services billed separately).

CPT 23465: Posterior Shoulder Capsular Repair

CPT-23412-OPEN-ROTATOR-CUFF-REPAIR-SHOULDER

CPT 23412: Open Surgical Repair of Chronic Rotator Cuff Tear

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

CPT 23395: Muscle Transfer to Shoulder or Upper Arm

CPT-23490-CLAVICLE-FIXATION-INTERNAL-FIXATION-CLAVICULAR-DEFECT

CPT 23490: Clavicle Fixation with Internal Implants

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

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

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

CPT 23480: Clavicle Osteotomy or Open Clavicular Reconstruction

CPT-23460-SHOULDER-CAPSULAR-REPAIR-WITH-BONE-BLOCK-GRAFT

CPT 23460: Shoulder Capsular Repair with Glenoid Bone Block Graft

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

CPT 23397: Multiple Muscle Transfer to Shoulder/Upper Arm

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

CPT 23473: Revision Shoulder Arthroplasty with Prosthesis Exchange

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

CPT 23485: Clavicle Osteotomy with Bone Graft and Fixation

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Taxonomy Code	Specialty	Notes
207T00000X	Orthopaedic Surgery	Primary specialty performing shoulder instability repairs, including arthroscopic Bankart procedures.
208800000X	Sports Medicine	Surgeons with sports medicine training commonly perform arthroscopic labral and capsular repairs.
363L00000X	Anesthesiology	Provides general anesthesia and regional nerve block services for shoulder surgery.
261Q00000X	Physical Medicine & Rehabilitation	Often manages postoperative rehabilitation referrals and nonsurgical care coordination.
363A00000X	Pain Medicine	May be involved for perioperative regional anesthesia planning (e.g., interscalene block).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S43.01`	Dislocation of right shoulder	Represents acute or recurrent shoulder dislocation prompting capsular repair for instability.
`S43.02`	Dislocation of left shoulder	Same as above for left-sided injuries requiring `LT` or `RT` modifiers to indicate laterality.
`M24.41`	Recurrent dislocation, right shoulder	Describes chronic or recurrent instability indicating surgical stabilization.
`M24.42`	Recurrent dislocation, left shoulder	Same clinical relevance for the left shoulder.
`M75.10`	Unspecified rotator cuff tear or rupture of unspecified shoulder	May coexist with labral or capsular injury and influence intraoperative management and coding.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`29806`	Arthroscopy, shoulder, surgical; capsulorrhaphy	Arthroscopic capsular repair technique commonly used for shoulder instability; may be reported when coding arthroscopic capsular plication approaches.
`29807`	Arthroscopy, shoulder, surgical; with repair of SLAP lesion	Performed when superior labral (SLAP) pathology is present in addition to anterior labral tears and may be billed alongside labral repair.
`23420`	Repair of capsular ligaments, shoulder; open treatment for unidirectional instability	Open capsular repair alternative when arthroscopic approach is not used; relates as an alternative technique.
`29822`	Arthroscopy, shoulder, surgical; synovectomy, partial	May be performed intraoperatively for synovitis or inflamed tissue encountered during diagnostic arthroscopy prior to labral repair.
`20930`	Allograft, muscle, tendon, or ligament, for graft; first stage	Used if augmentation with graft is required for significant capsular deficiency or revision cases and may be performed in staged reconstructions.

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