Summary & Overview
CPT 23470: Shoulder Hemiarthroplasty, Humeral Head Replacement
CPT code 23470 denotes glenohumeral joint hemiarthroplasty, an orthopedic surgical procedure replacing the humeral head with a prosthetic implant while leaving the glenoid intact. The code is used when shoulder joint disease or injury primarily affects the humeral head and a partial joint replacement is clinically indicated. Nationally, this procedure is relevant for orthopedic surgery utilization, hospital surgical volume, and joint-replacement cost and quality monitoring.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the service, typical sites of care, common modifiers, and guidance on coding relationships where available. The publication summarizes benchmarks and reimbursement patterns, highlights policy updates affecting joint-replacement coverage, and outlines clinical considerations that influence coding and site-of-service decisions.
The report provides practical reference material for billing and coding teams, revenue cycle managers, and policy analysts, including common billing modifiers supplied in the input and notes on when hemiarthroplasty is selected over total shoulder arthroplasty. Data not available in the input are explicitly noted where applicable.
Billing Code Overview
CPT code 23470 describes a glenohumeral joint hemiarthroplasty, a surgical procedure in which the damaged head of the humerus is replaced with a prosthetic implant while the glenoid cavity (the socket) is left intact. This procedure is performed when degenerative disease, post-traumatic damage, or other pathology affects the humeral head but spares the glenoid.
Service type: Surgical — Orthopedic / Joint Replacement
Typical site of service: Hospital inpatient or outpatient surgery center, depending on clinical factors and payer policies. Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 72-year-old right-hand–dominant patient presents with progressive, activity-limiting shoulder pain, stiffness, and reduced range of motion over several years. Physical exam demonstrates diminished abduction, external rotation, and point tenderness over the anterolateral shoulder. Imaging (plain radiographs and CT) shows advanced arthritic destruction isolated to the humeral head with relative preservation of the glenoid surface. Conservative measures including physical therapy, oral analgesics, intra-articular corticosteroid injection, and activity modification have failed.
The orthopedic surgeon schedules a glenohumeral joint hemiarthroplasty. In the preoperative workflow, the patient completes pre-op clearance, informed consent, and templating to determine implant size. The procedure is typically performed in an acute-care hospital operating room or ambulatory surgical center under general anesthesia with regional nerve block. The surgeon removes the irreparable humeral head and implants a prosthetic humeral head while leaving the native glenoid intact. Postoperative care includes pain control, immobilization in a sling, early passive and then active-assisted range-of-motion rehabilitation, and routine follow-up to monitor implant position and function.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Service not covered by payer-specific modifier set (placeholder) | Use only if payer requires a specific administrative value per their guidance (rare). |