Introduction
Rotator cuff injuries are a common cause of shoulder pain and dysfunction, often requiring arthroscopic or open surgical intervention. Correct CPT coding is crucial for accurate billing and reimbursement. This guide provides a comprehensive overview of rotator cuff repair and related shoulder arthroscopy CPT codes, along with billing guidelines, modifier use, and a final reference table including CPT code descriptions and RVUs.
Understanding Rotator Cuff Repair & Shoulder Arthroscopy
Rotator cuff repair can be performed arthroscopically or via an open approach, depending on the severity of the tear. Additional procedures, such as biceps tenodesis, debridement, or acromioplasty, are often performed during the same session, requiring correct CPT coding to avoid bundling issues.
CPT Codes for Rotator Cuff Repair & Shoulder Arthroscopy
Primary Rotator Cuff Repair CPT Code
- 29827 – Arthroscopy, shoulder, surgical; with rotator cuff repair.
- Used for arthroscopic repair of the rotator cuff.
- Bundled procedures: Cannot be billed with 29826 (acromioplasty) in most cases.
Related Shoulder Arthroscopy Codes
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29806 – Arthroscopy, shoulder, surgical; capsulorrhaphy.
- Used for labral repair and shoulder instability corrections.
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29807 – Arthroscopy, shoulder, surgical; repair of SLAP lesion.
- Used for superior labrum anterior-posterior (SLAP) tear repairs.
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29824 – Arthroscopy, shoulder, surgical; distal claviculectomy (Mumford procedure).
- Used for resection of the distal clavicle due to AC joint arthritis.
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29826 – Arthroscopy, shoulder, surgical; decompression/acromioplasty.
- Frequently bundled with 29827—only bill separately if performed for separate pathology.
Open Surgical Rotator Cuff & Shoulder Repair Codes
- 23410 – Open repair of ruptured rotator cuff, acute.
- 23412 – Open repair of ruptured rotator cuff, chronic.
- These are used when rotator cuff repair is done via open surgery instead of arthroscopy.
Biceps Tenodesis & Tenotomy Codes
- 23430 – Open tenodesis of long tendon of biceps.
- 29828 – Arthroscopic biceps tenodesis.
- These codes are used when the biceps tendon is repaired or repositioned.
Billing Guidelines & Modifier Usage
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Common Modifiers:
- -RT/-LT – Indicates right or left shoulder.
- -59 – Used when reporting unbundled procedures.
- -22 – Used when the procedure is significantly more complex than usual.
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Bundling Considerations:
- 29826 (acromioplasty) is often bundled with 29827 (rotator cuff repair).
- 29806 (capsulorrhaphy) and 29807 (SLAP repair) may be reported separately if both are performed.
Common Denials & How to Avoid Them
- Bundling Errors: Ensure proper use of modifiers if reporting multiple procedures.
- Lack of Medical Necessity: Clearly document MRI findings, functional impairment, and conservative treatment failure.
- Global Surgery Period Considerations: Rotator cuff repairs have a 90-day global period—follow-up visits within this timeframe must be coded properly.
Final CPT Code Table: Descriptions & RVUs
| CPT Code | Description | RVU |
|---|---|---|
| 29827 | Arthroscopy, shoulder, with rotator cuff repair | 14.00 |
| 29806 | Arthroscopy, shoulder, with capsulorrhaphy | 12.50 |
| 29807 | Arthroscopy, shoulder, SLAP repair | 13.10 |
| 29824 | Arthroscopy, shoulder, distal claviculectomy | 10.23 |
| 29826 | Arthroscopy, shoulder, acromioplasty | 9.57 |
| 29828 | Arthroscopy, shoulder, biceps tenodesis | 11.89 |
| 23410 | Open repair of rotator cuff, acute | 16.75 |
| 23412 | Open repair of rotator cuff, chronic | 17.25 |
| 23430 | Open tenodesis of biceps tendon | 13.90 |
Conclusion
Proper CPT coding for rotator cuff repair and shoulder arthroscopy is essential for maximizing reimbursement and reducing denials. Understanding bundling rules, modifier application, and payer-specific guidelines will help ensure accurate claims.
If this guide was useful, check out our other orthopedic CPT coding guides for knee, hip, and spinal surgeries!