Summary & Overview
CPT 29806: Arthroscopic Shoulder Joint Inspection with Capsule Repair
CPT code 29806 denotes arthroscopic inspection of the shoulder joint with operative repair of tears in the joint capsule. This minimally invasive orthopedic procedure is commonly used to address capsular injuries that can result from falls, twisting mechanisms, or direct blows that may lead to shoulder instability or dislocation. Nationally, arthroscopic shoulder procedures like this are a frequent component of orthopedic surgical practice and relevant to hospital outpatient departments, ambulatory surgical centers, and payer policy on surgical authorization and reimbursement.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, common claim modifiers associated with operative arthroscopy, and a summary of areas where payer policy and coding practice commonly intersect, such as bundling, global surgical periods, and postoperative care considerations. The publication also outlines benchmarks and coding comparisons relevant for billing teams, revenue cycle managers, and policy analysts.
This resource is intended as a national overview to orient clinicians and billing professionals to the clinical meaning and administrative considerations of CPT code 29806. Data not available in the input is indicated where applicable.
Billing Code Overview
CPT code 29806 describes an arthroscopic procedure in which the provider inspects the interior of the shoulder joint with an arthroscope and inserts instruments to repair tears in the joint capsule. The procedure addresses tearing of the joint capsule that can occur from trauma such as a fall on an outstretched arm, a twisting injury, or a forceful blow to the shoulder and that may be associated with shoulder dislocation.
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Service type: Arthroscopic shoulder joint inspection with repair of joint capsule tears (operative arthroscopy)
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Typical site of service: Outpatient surgical center or hospital operating room for orthopedic surgery
Clinical & Coding Specifications
Clinical Context
A 34-year-old male presents to the orthopedic clinic after a fall onto an outstretched arm during a bicycle accident. He reports immediate shoulder pain, instability, and an episode of anterior dislocation that was reduced in the emergency department. Physical exam demonstrates anterior shoulder laxity and persistent pain with overhead activity. Imaging (radiographs and MRI) shows a Bankart lesion with detachment of the anteroinferior labrum and capsular laxity. After failed conservative management including physical therapy and activity modification over six weeks, the orthopedic surgeon schedules an arthroscopic shoulder stabilization with labral repair.
Preoperative workflow includes pre-op history and physical, informed consent, anesthesia evaluation (regional block or general anesthesia), and surgical time-out. Intraoperative steps: diagnostic glenohumeral arthroscopy to inspect cartilage, labrum, and capsule; preparation of glenoid rim; insertion of suture anchors and passage of sutures to reattach the labrum; capsular plication as indicated; hemostasis and closure. Postoperative workflow includes PACU recovery, immobilization in a sling, discharge instructions, and outpatient physical therapy for graduated range-of-motion and strengthening.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
RT | Right side | When the procedure is performed on the right shoulder |