CPT 23460 Shoulder Bone Block Reimbursement | OpenPayer

Summary & Overview

CPT 23460: Shoulder Capsular Repair with Glenoid Bone Block Graft

CPT code 23460 represents an open shoulder stabilization surgery that repairs and tightens the glenoid joint capsule for severe instability and hyperlaxity and includes a bone block graft from the scapula to reconstruct the glenoid. This operative code is important nationally because it covers definitive surgical management for patients with recurrent anterior shoulder instability and substantial glenoid bone loss — a condition that, if untreated, can lead to recurrent dislocation, chronic pain, and functional impairment.

Key national payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when the procedure is used, typical sites of service, and the kinds of benchmarks and policy topics that commonly affect billing and coverage (authorization requirements, inpatient versus outpatient site determinations, and bundling considerations). The publication also outlines relevant coding relationships and common billing modifiers where applicable.

This summary is intended for clinicians, billing professionals, and policy analysts seeking a focused reference on the clinical intent and payer landscape for CPT code 23460, along with pointers to the operational and policy issues that most commonly influence reimbursement and utilization nationally.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 23460shoulder stabilizationorthopedic surgerycapsular repairbone block graftglenoid reconstructionsurgical proceduresoutpatient surgery

Billing Code Overview

CPT code 23460 describes an open shoulder stabilization procedure that repairs a tear in the glenoid capsule and tightens the joint capsule for patients with hyperlaxity and severe shoulder instability. The procedure also includes a bone block reconstruction in which the damaged portion of the glenoid cavity is replaced with a graft from the scapula (shoulder blade).

Service type: Surgical procedure — open shoulder stabilization with capsular repair and bone grafting
Typical site of service: Hospital operating room or outpatient surgical center

Clinical & Coding Specifications

Clinical Context

A 28-year-old male military recruit presents after recurrent anterior shoulder dislocations following a traumatic fall during training. He reports multiple instability episodes with persistent pain, apprehension, and decreased activity tolerance despite conservative management including physical therapy and activity modification. Imaging (MRI and CT) demonstrates a Bankart lesion with capsular laxity and anteroinferior glenoid bone loss. The orthopedic surgeon schedules an open capsulolabral repair with capsular plication and an iliac crest or coracoid bone block (glenoid augmentation) to restore stability.

Preoperative workflow includes history and physical, informed consent outlining risks (stiffness, recurrent instability, graft complications), pre-op imaging review, anesthesia evaluation, and marking the operative side. Intraoperatively, the provider performs repair of the torn joint capsule and tightens the capsule for hyperlaxity, and proceeds with the bone block graft to reconstruct the damaged glenoid. Postoperative care includes immobilization in a sling, pain management, wound care, and a staged rehabilitation plan progressing from passive range of motion to strengthening over months. Typical site of service is an ambulatory surgical center or hospital outpatient department; inpatient stay is uncommon unless there are complications or additional procedures.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services

Related Codes

CPT-23472-TOTAL-SHOULDER-ARTHROPLASTY

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

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

CPT 23480: Clavicle Osteotomy or Open Clavicular Reconstruction

CPT-23420-SHOULDER-RECONSTRUCTION-ACROMIOPLASTY

CPT 23420: Shoulder Reconstruction with Acromioplasty

CPT-23465-POSTERIOR-SHOULDER-CAPSULAR-REPAIR

CPT 23465: Posterior Shoulder Capsular Repair

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

CPT 23440: Biceps Tenodesis for Shoulder Stabilization

CPT-23450-SHOULDER-CAPSULAR-REPAIR-TIGHTENING

CPT 23450: Shoulder Capsular Repair and Tightening

CPT-23406-SHOULDER-MULTIPLE-TENOTOMY

CPT 23406: Multiple Tenotomy of Shoulder

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

CPT 23473: Revision Shoulder Arthroplasty with Prosthesis Exchange

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

CPT 23490: Clavicle Fixation with Internal Implants

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

CPT 23491: Proximal Humerus Fixation with Internal Implants

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Taxonomy Code	Specialty	Notes
207L00000X	Orthopaedic Surgery	Primary specialty performing shoulder stabilization and bone block procedures.
207LP2900X	Sports Medicine (Orthopaedic)	Common for athletes and active patients with recurrent instability.
208000000X	General Surgery	Occasionally involved in complex reconstructions in multidisciplinary centers.
2087S0123X	Physical Medicine & Rehabilitation	Manages postoperative rehabilitation and functional recovery.
207RH0000X	Hand Surgery (Orthopaedic specialization)	May be involved when upper extremity reconstruction requires microsurgical expertise.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M24.411`	Recurrent dislocation, right shoulder	Recurrent instability is a primary indication for capsular repair and glenoid reconstruction.
`M24.412`	Recurrent dislocation, left shoulder	As above, indicating the left shoulder.
`S43.011A`	Dislocation of right glenohumeral joint, initial encounter	Acute traumatic dislocation that can lead to chronic instability requiring surgical repair.
`S43.012A`	Dislocation of left glenohumeral joint, initial encounter	Acute left-sided event that may progress to instability.
`M75.01`	Adhesive capsulitis of right shoulder	Differential diagnosis; capsular procedures may be relevant if stiffness coexists, but surgical approach differs.
`M75.02`	Adhesive capsulitis of left shoulder	As above for left shoulder.
`M19.011`	Primary osteoarthritis, right shoulder	Glenoid wear may influence decision-making for grafting versus arthroplasty in older patients.
`M19.012`	Primary osteoarthritis, left shoulder	As above for left side.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`29806`	Arthroscopy, shoulder, surgical; capsulorrhaphy	Minimally invasive alternative for capsular repair when bone loss is minimal; may be performed prior to deciding on open bone block.
`23462`	Repair of capsular shift or labral repair, with or without release of subscapularis, open; with bone graft (includes harvesting)	Closely related open shoulder stabilization with bone grafting — often used for glenoid augmentation procedures.
`23465`	Repair of recurrent dislocation, with coracoid transfer (Latarjet)	Specific bone block procedure (coracoid transfer) performed to restore anterior glenoid stability; an alternative technique to scapular grafting.
`20680`	Removal of implant; deep (e.g., plates, screws)	May be necessary postoperatively if hardware from graft fixation causes symptoms or complications.
`29807`	Arthroscopy, shoulder, surgical; capsular release	May be performed in staged care for stiffness after open stabilization or as part of combined arthroscopic/open approaches.
`99024`	Postoperative follow-up visit, global period	Represents routine postoperative care during the global period for surgical procedures (used per payer guidelines).