CurrentSelectHealthPolicy # 72

Shoulder arthroscopic debridement reimbursement

Defines SelectHealth's reimbursement stance for arthroscopic shoulder debridement codes (limited 29822 and extensive 29823) when performed with other arthroscopic shoulder procedures, and indicates which lines of business follow the policy.

Policy Summary

PayerSelectHealth

PolicyShoulder arthroscopic debridement reimbursement

Policy CodePolicy Policy # 72

Change TypeNo material change

Effective Date

Next Review Date

Key ActionDo not separately reimburse limited arthroscopic debridement (29822) when performed on the same shoulder as another arthroscopic shoulder procedure.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

29822Limited debridement code

29823Extensive debridement code

Commercial, Advantage, Community CareApplies to lines of business

2017Referenced guidance year

Shoulder Debridement Coverage Criteria

Shoulder debridement coverage criteria

SelectHealth reimbursement rules for arthroscopic shoulder debridement codes.

Covered when ALL of the following reimbursement rules are met:

Limited debridement (CPT 29822)

CPT 29822 (arthroscopy, shoulder; surgical; debridement; limited) is not separately reimbursed when performed on the same shoulder as another arthroscopic shoulder procedure (e.g., 29805-29824, 29827-29828).
Exception: a limited debridement (29822) performed on the opposite shoulder may be separately payable.

Extensive debridement (CPT 29823)

CPT 29823 (arthroscopy, shoulder; surgical; debridement; extensive) may be allowed for separate reimbursement when performed with CPT 29824 (distal claviculectomy), CPT 29827 (rotator cuff repair), or CPT 29828 (biceps tenodesis).

Policy Summary

PayerSelectHealth

PolicyShoulder arthroscopic debridement reimbursement

Policy CodePolicy Policy # 72

Change TypeNo material change

Effective Date

Next Review Date

Key ActionDo not separately reimburse limited arthroscopic debridement (29822) when performed on the same shoulder as another arthroscopic shoulder procedure.

SourceLink

On This Page

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CPT Codes and Documentation Standards

Relevant CPT codes and descriptionsCPT

29822	Arthroscopy, shoulder; surgical; debridement; limited.
29823	Arthroscopy, shoulder; surgical; debridement; extensive.
29824	Arthroscopy, shoulder; surgical; distal claviculectomy including distal articular surface (Mumford procedure).
29827	Arthroscopy, shoulder; surgical; (rotator cuff repair) — referenced.
29828	Arthroscopy, shoulder; surgical; biceps tenodesis.
29826	Add-on code (context: can be billed with 29822 as primary).

Limited debridement billing noteCPT

29822	Arthroscopy, shoulder; surgical; debridement; limited. (Can be billed as the primary procedure when performed with add-on CPT 29826).
29826	Add-on code (context: can be billed with 29822 as primary).

Extensive debridement pairingCPT

29823	Arthroscopy, shoulder; surgical; debridement; extensive. (May be allowed with 29824, 29827, or 29828 if documentation supports extensive debridement in a different area of the shoulder).
29824	Arthroscopy, shoulder; surgical; distal claviculectomy including distal articular surface (Mumford procedure).
29827	Arthroscopy, shoulder; surgical; (rotator cuff repair) — referenced.
29828	Arthroscopy, shoulder; surgical; biceps tenodesis.

Documentation standard for separate reimbursement of 29823

RequirementDocumentation must clearly support that CPT 29823 (extensive arthroscopic debridement) was extensive and performed in a different area of the shoulder than the other billed procedure.

Supporting proceduresSeparate payment for 29823 may be allowed when performed with CPT 29824 (distal claviculectomy), 29827 (rotator cuff repair), or 29828 (biceps tenodesis) if documentation meets the requirement.

CMS precedent2017 CMS determination allows separate payment for extensive debridement under these conditions; documentation must reflect extent and distinct anatomical area.

Burden of proofOperative report and supporting notes must describe extent of debridement and specify a different area of the shoulder to justify separate reimbursement.

Billing and Prior Authorization Guidance

Billing Rule

Billing and prior authorization: shoulder debridement (29822/29823)

Do not separately bill limited arthroscopic debridement (CPT 29822) when it is performed on the same shoulder during the same surgical session as another arthroscopic shoulder procedure; 29822 is included in the global surgical package and is not separately payable (exception: limited debridement on the opposite shoulder). CPT 29822 may be billed as the primary procedure only when performed with add‑on CPT 29826. Extensive debridement (CPT 29823) may be allowed separately with CPT 29824, 29827, or 29828 only if documentation demonstrates the debridement was extensive and performed in a different area of the shoulder.

29822 is included in the global surgical package and not separately payable when done on the same shoulder with other arthroscopic shoulder procedures; exception: opposite shoulder.
29822 may be billed as the primary procedure when performed with add‑on code 29826.
29823 may be separately allowed with 29824, 29827, or 29828 only if documentation supports extensive debridement in a different shoulder area (per CMS 2017 guidance).

Key Definitions

Anatomical structure (shoulder)

DefinitionFor coding and reimbursement, the shoulder is considered one anatomical structure.

ImplicationDebridement performed on the same shoulder during the same surgical session is included in the global surgical package unless specific exceptions apply.

Opposite shoulderProcedures performed on the opposite shoulder are treated separately (e.g., limited debridement on opposite shoulder may be separately payable).

Extensive vs limited debridement (29823 vs 29822)

Separation ruleLimited debridement (CPT 29822) is included in the global package and is not separately payable when performed on the same shoulder during the same surgical session.

Exception for limited debridementLimited debridement (29822) billed separately may be allowed only when performed on the opposite shoulder.

Extensive debridementExtensive debridement (CPT 29823) may be separately reimbursed if documentation shows it was extensive and performed in a different area of the shoulder than the other procedure.

Billing interactionCPT 29822 can be billed as the primary procedure when performed with add-on CPT 29826; 29823 separability has specific documentation requirements when billed with 29824, 29827, or 29828.