{"id":180120,"date":"2026-08-14T08:38:26","date_gmt":"2026-08-14T08:38:26","guid":{"rendered":"https:\/\/pabau.com\/?p=180120"},"modified":"2026-08-14T08:59:29","modified_gmt":"2026-08-14T08:59:29","slug":"cpt-code-23472","status":"publish","type":"post","link":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-23472\/","title":{"rendered":"CPT code 23472: Total shoulder arthroplasty billing guide"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT Code 23472: Total shoulder arthroplasty billing guide\",\"description\":\"CPT code 23472 covers total shoulder arthroplasty, both the glenoid and the proximal humeral components. See the 2026 Medicare rate, RVU values, modifiers, and documentation requirements.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-23472\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-08-10\",\"dateModified\":\"2026-08-14\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>CPT code 23472 covers total shoulder arthroplasty, the replacement of both the glenoid and the proximal humeral components.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Use 23472 only when both components are replaced, because 23470 covers hemi-arthroplasty and is not interchangeable.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>The same code reports a reverse total shoulder arthroplasty, since CPT has no separate entry for the reverse configuration.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>CPT 23472 carries 38.93 total RVUs in 2026, worth about $1,300 at the national conversion factor of $33.4009.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Append LT or RT on every claim, and add modifier 22 only with an operative note that documents the extra work.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">CPT code 23472 is the billable code for total shoulder arthroplasty, the replacement of both the glenoid and the proximal humeral components. The surgeon resurfaces the whole glenohumeral joint, which is what separates 23472 from the hemi-arthroplasty billed under 23470.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt\/cpt-code-set-overview\" target=\"_blank\" rel=\"nofollow noopener\">AMA CPT code set<\/a> places 23472 in the Musculoskeletal System section, under shoulder repair, revision, and reconstruction. Its official descriptor reads: Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement). That parenthetical is the operative phrase, because both components must be surgically replaced for the code to apply.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Field<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Detail<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">23472<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Official descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT section<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Musculoskeletal System, shoulder<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Global surgical period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">90 days<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Procedure type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Major surgery, with bilateral capability under an LT or RT modifier<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Typical setting<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Hospital inpatient, hospital outpatient, or an ambulatory surgery center on the Medicare covered procedures list<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The 90-day global surgical period bundles most follow-up visits and routine post-operative care into the 23472 payment. Billing an evaluation and management (E\/M) service separately inside that window requires modifier 24 for an unrelated condition, or modifier 79 for an unrelated procedure. Coders who miss the rule create avoidable denials and overpayment exposure.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"CPT Coding Pitfalls Every Medical Practice Faces\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/vbvV5okdXKg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 id=\"h-indications-and-medical-necessity\" class=\"wp-block-heading\">Indications and medical necessity<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medical necessity documentation is the most common reason total shoulder arthroplasty claims are denied or audited. The operative report and the pre-authorization request must each tie 23472 to a qualifying diagnosis. Payers generally want evidence that conservative management was tried and failed first.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Requirements for pairing diagnosis codes vary by Medicare Administrative Contractor (MAC) jurisdiction, so confirm the applicable Local Coverage Determination before you submit. The diagnoses below are the ones that usually support the code.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Severe glenohumeral osteoarthritis (ICD-10 M19.011, M19.012)<\/li>\n\n\n\n<li>Rheumatoid arthritis of the shoulder (ICD-10 M06.011 or M06.012 without rheumatoid factor, M05.711 or M05.712 with it)<\/li>\n\n\n\n<li>Post-traumatic arthritis following prior fracture or dislocation (ICD-10 M19.211, M19.212)<\/li>\n\n\n\n<li>Avascular necrosis of the humeral head (ICD-10 M87.021, M87.022)<\/li>\n\n\n\n<li>Failed prior hemi-arthroplasty with glenoid involvement, converted to a total replacement<\/li>\n\n\n\n<li>Cuff tear arthropathy that has not responded to conservative care<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">One point catches coders out: 23472 also reports a reverse total shoulder arthroplasty. The code set has no separate entry for the reverse configuration, so the implant design does not change the code you bill. Cuff tear arthropathy is the classic indication, and the underlying tear is often reported alongside a code such as <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-m75121\/\">M75.121<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Groups that run <a href=\"https:\/\/pabau.com\/industry\/sports-medicine-software\/\">sports medicine<\/a> and <a href=\"https:\/\/pabau.com\/industry\/physical-therapy-emr\/\">physical therapy<\/a> caseloads alongside surgery can prevent most pre-authorization denials with a pre-visit documentation routine. When the surgeon&rsquo;s notes, imaging reports, and conservative treatment history sit in one place before the procedure date, the authorization packet nearly writes itself.<\/p>\n\n\n\n<h2 id=\"h-medicare-reimbursement-for-cpt-code-23472\" class=\"wp-block-heading\">Medicare reimbursement for CPT code 23472<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Total shoulder arthroplasty sits among the higher-paid musculoskeletal codes in the Medicare Physician Fee Schedule. Payment varies by locality through the Geographic Practice Cost Index (GPCI), so a Manhattan practice is paid differently from one in rural Mississippi. Use the <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS fee schedule lookup<\/a> to pull locality-specific rates for your MAC jurisdiction.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The table below shows approximate 2026 national unadjusted rates for the physician professional fee. Verify the figures against the 2026 MPFS final rule before you submit, since rates update annually and adjust geographically.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Payment setting<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Approx. 2026 Medicare national rate<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Facility (hospital inpatient or outpatient)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">~$1,300 (physician professional fee)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The facility is paid separately under OPPS, the DRG, or the ASC rate<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Non-facility (office-based, rare)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">~$1,300 (if applicable)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CMS lists identical facility and non-facility RVUs for this code<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Geographic adjustment range<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Approximately 0.80x to 1.20x the national rate<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Driven by GPCI locality; confirm with the CMS look-up tool<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Commercial contracts rarely mirror these numbers. Many pay a negotiated multiple of the Medicare rate, so track each payer&rsquo;s fee schedule separately instead of using Medicare as a proxy.<\/p>\n\n\n\n<h3 id=\"h-rvu-breakdown-and-the-2026-conversion-factor\" class=\"wp-block-heading\">RVU breakdown and the 2026 conversion factor<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Relative Value Units (RVUs) drive the payment amount. CMS publishes the component values in the <a href=\"https:\/\/www.cms.gov\/medicare\/payment\/fee-schedules\/physician\/pfs-relative-value-files\" target=\"_blank\" rel=\"nofollow noopener\">PFS relative value files<\/a>, which is the source to check before you model reimbursement for the year.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">RVU component<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">2026 value<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">What it represents<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Work RVU (wRVU)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">21.58<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Physician time, skill, and mental effort<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Practice Expense RVU (PE RVU)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">12.99<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Overhead costs allocated to the procedure<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Malpractice RVU (MP RVU)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">4.36<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Professional liability insurance allocation<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Total RVU<\/td>\n<td style=\"padding:12px 16px;color:#374151\">38.93<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Identical in facility and non-facility settings<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Multiply the total by the conversion factor to reach the pre-GPCI payment. The 2026 factor is $33.4009 for most clinicians and $33.5675 for qualifying APM participants, which puts 23472 at roughly $1,300. A work RVU of 21.58 also places it just above the major lower-limb replacements at <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-27130\/\">27130<\/a> and <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-27447\/\">27447<\/a>.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Verify your locality-specific GPCI before projecting reimbursement. Practices in high-cost metros like San Francisco or New York can see rates 15-20% above the national benchmark. Rural areas often fall 10-15% below. Use the CMS Physician Fee Schedule look-up tool, filtered to your MAC jurisdiction, for accurate planning.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-modifiers-for-cpt-code-23472\" class=\"wp-block-heading\">Modifiers for CPT code 23472<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The wrong modifier on a 23472 claim triggers a denial, an NCCI edit violation, or a post-payment audit. Each modifier tells the payer something specific about the clinical circumstances. The table below covers the ones used most often with this code.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Name<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to apply<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">LT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Left side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Required to identify laterality on every shoulder procedure. Never omit it.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">RT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Right side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Required to identify laterality on every shoulder procedure. Never omit it.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">22<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Increased procedural services<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Append when the case took substantially more work than usual, such as severe deformity or a failed prior implant. Include an operative note explaining the added complexity. Payer acceptance varies, so confirm before billing.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">59<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Distinct procedural service<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Overrides NCCI bundling edits when a separately billable procedure occurs at a distinct session, site, or indication. Apply only where it is clinically warranted and documented.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">50<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bilateral procedure<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Rarely applicable to total shoulder arthroplasty. If both shoulders are replaced in one session, append modifier 50. Payment is typically 150% of the single-procedure rate.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">78<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unplanned return to the OR, related procedure<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Applies inside the 90-day global period when a complication sends the patient back to the operating room for a related procedure.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">LT and RT are not optional on Medicare claims. Submit 23472 without a laterality modifier and most MACs will reject it. Software that enforces modifier rules at charge entry stops those rejections before the claim leaves the practice.<\/p>\n\n\n\n<h2 id=\"h-documentation-that-supports-the-claim\" class=\"wp-block-heading\">Documentation that supports the claim<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A clean 23472 claim starts long before the patient reaches the operating room. Pre-authorization records, the operative report, and post-operative notes all decide whether the claim survives review. MAC auditors look for specific elements in each one.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Build a pre-authorization checklist in your practice management system that mirrors the list below. Confirm every element is on file before the charge drops, because chasing a missing document after submission is what stretches a denial into weeks.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-23472\/automate-claims-through-healthcode.webp\" alt=\"Pabau checkout screen raising an insurer invoice for a completed procedure\"\/><figcaption class=\"wp-element-caption\"><em>Pabau raises the insurer invoice at checkout, so the surgical charge is captured against the visit before the claim goes out.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Pre-authorization packet:<\/strong> Diagnosis with ICD-10 code, imaging reports, a record of failed conservative treatment, and the surgeon&rsquo;s attestation of medical necessity<\/li>\n\n\n\n<li><strong>Operative report:<\/strong> Surgical approach, confirmation that the glenoid and humeral components were both implanted, and the implant manufacturer and lot number. Note any complications, plus the procedure duration if modifier 22 applies<\/li>\n\n\n\n<li><strong>Anesthesia documentation:<\/strong> Separate from the surgeon&rsquo;s note, and required before the anesthesiologist can bill<\/li>\n\n\n\n<li><strong>Post-operative plan:<\/strong> Discharge instructions, rehabilitation referral, and the follow-up schedule inside the 90-day global period<\/li>\n\n\n\n<li><strong>ICD-10 linkage:<\/strong> The primary diagnosis must map to a recognized indication, so avoid unspecified codes such as <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-m1990\/\">M19.90<\/a> when the record supports M19.011<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-software\/\">HIPAA-compliant record keeping<\/a> across the episode of care also builds the audit trail you need when a payer requests documentation after payment. Practices that keep pre-auth approvals, operative notes, and post-visit records in one <a href=\"https:\/\/pabau.com\/features\/medical-records-management\/\">clinical documentation tool<\/a> answer those requests in minutes.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-23472\/comprehensive-patient-records.webp\" alt=\"Pabau patient record showing profile details next to a timeline of scheduled and completed activity\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&rsquo;s patient record keeps pre-authorization notes and follow-up activity on one timeline, so an audit response takes minutes instead of hours.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 id=\"h-related-shoulder-arthroplasty-codes\" class=\"wp-block-heading\">Related shoulder arthroplasty codes<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Picking the wrong code from the shoulder arthroplasty family is the most common upcoding or downcoding error in this subspecialty. The codes at 23470, 23472, 23473, and 23474 each describe a distinct procedure. What separates them is which components are replaced, and whether the case is primary or revision.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Descriptor summary<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Key distinction<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">23470<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Hemi-arthroplasty, humeral head only<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The glenoid is not replaced. Use it when only the proximal humerus is implanted.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">23472<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Total shoulder arthroplasty, glenoid and humeral<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Both components are replaced. This code, and the primary procedure.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">23473<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Revision, humeral or glenoid component only<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Single-component revision of a previously placed arthroplasty.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">23474<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Revision, total shoulder, glenoid and humeral<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Both components revised. Higher complexity than 23473, and it needs detailed operative documentation.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\"><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-23670\/\">23670<\/a><\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open treatment of shoulder dislocation with greater tuberosity fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Trauma code for the injury that can later drive an arthroplasty.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\"><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-23146\/\">23146<\/a><\/td>\n<td style=\"padding:12px 16px;color:#374151\">Excision of bone cyst or benign tumor, proximal humerus, with autograft<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Same anatomic area, but no joint replacement is involved.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\"><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-23030\/\">23030<\/a><\/td>\n<td style=\"padding:12px 16px;color:#374151\">Incision and drainage, shoulder area, deep abscess<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Often paired with modifier 78 when infection sends the patient back to the OR.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">23430<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Tenodesis of the long tendon of biceps<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Adjacent shoulder procedure. It may be billable alongside arthroplasty, depending on NCCI status and payer policy.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">29823<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Arthroscopy, shoulder, extensive debridement<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Arthroscopic code, distinct from open arthroplasty. Not bundled with 23472 under standard NCCI edits.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The 23472 versus 23470 line is where auditors look first. An operative report that describes implanting a glenoid component, on a claim coded to 23470, is downcoding and leaves money behind. Coding 23472 when the note confirms only the humeral head was replaced is upcoding. The operative report governs, not what the surgeon says afterward.<\/p>\n\n\n\n<h2 id=\"h-how-pabau-supports-orthopedic-billing\" class=\"wp-block-heading\">How Pabau supports orthopedic billing<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A missing laterality modifier or an incomplete pre-auth packet turns a $1,300 claim into a 45-day denial cycle. So does an operative note that never confirms both components were implanted. At ten or more shoulder replacements a month, those delays compound quickly.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau gives orthopedic billing teams a structured path from charge capture through to submission. Procedure codes and modifiers are entered against the patient record. Pre-authorization notes sit with the clinical documentation, and claim status is tracked in one view.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Instead of reconciling a spreadsheet against a payer portal, the billing team can see where each 23472 claim sits in the cycle. Pabau&rsquo;s <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">claims management software<\/a> also ties ICD-10 diagnosis codes to procedures at the point of care. That cuts how often a coder has to chase the surgeon for a clarification.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Set up a charge capture checklist for 23472 inside your practice management system. Include the LT or RT modifier, the ICD-10 primary diagnosis, the pre-auth reference number, implant documentation, and the global period start date. A 60-second check at charge entry prevents a 45-day denial cycle.<\/p>\n            <\/div>\n        <\/div>\n    \n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Simplify orthopedic claim submissions with Pabau                <\/h3>\n\n                <p class=\"description\">\n                    Pabau&rsquo;s claims management tools help orthopedic practices capture charges accurately, enforce modifier rules, and track claim status in one place. See how it works for high-value surgical codes like CPT 23472.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau claims management dashboard for orthopedic billing\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Total shoulder arthroplasty pays well enough that the documentation burden is worth carrying properly. The difference between a paid 23472 and a denied one is usually a single line in the operative report, or a two-character modifier.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Decide which of those two to fix first. Most practices get more back from tightening the pre-authorization packet than from arguing denials afterward. The packet is the only part of the episode you fully control before surgery.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how Pabau structures charge capture, modifier rules, and claim tracking for orthopedic practices.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Coding a shoulder trauma case?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-23670\/\">CPT code 23670<\/a> covers open treatment of a dislocation with a greater tuberosity fracture.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing a bone graft harvest?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-20939\/\">CPT code 20939<\/a> sets out when marrow aspiration is separately reportable.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Documenting an upper arm contusion?<\/strong> <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s40022a\/\">ICD-10 code S40.022A<\/a> explains the laterality and encounter rules that trip up first claims.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Managing a post-operative shoulder infection?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-23030\/\">CPT code 23030<\/a> walks through incision and drainage billing inside the global period.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1786693314577\"><h3 class=\"schema-faq-question\">What does CPT code 23472 cover?<\/h3> <p class=\"schema-faq-answer\">CPT code 23472 covers total shoulder arthroplasty, the surgical replacement of both the glenoid socket and the proximal humeral ball. It does not apply when only one component is replaced. Use 23470 for hemi-arthroplasty, and 23473 or 23474 for revision procedures.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786693314578\"><h3 class=\"schema-faq-question\">What is the Medicare reimbursement rate for CPT 23472?<\/h3> <p class=\"schema-faq-answer\">The 2026 Medicare national unadjusted rate is about $1,300 for the physician professional fee. That figure is 38.93 total RVUs multiplied by the $33.4009 conversion factor. Geographic Practice Cost Index (GPCI) adjustments move actual payment by locality. Check the CMS fee schedule look-up tool for your MAC before you quote a number.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786693314579\"><h3 class=\"schema-faq-question\">What modifiers are used with CPT code 23472?<\/h3> <p class=\"schema-faq-answer\">LT for the left side or RT for the right side is mandatory on every 23472 claim. Modifier 22 applies when the case took substantially more work than usual, supported by detailed operative documentation. Modifier 59 marks a distinct procedural service and overrides applicable NCCI bundling edits. Modifier 78 covers an unplanned return to the operating room during the 90-day global period.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786693314584\"><h3 class=\"schema-faq-question\">Does CPT 23472 cover reverse total shoulder arthroplasty?<\/h3> <p class=\"schema-faq-answer\">Yes. CPT has no separate entry for the reverse configuration, so 23472 reports both anatomic and reverse total shoulder arthroplasty. Record the configuration and the implant details in the operative note anyway, because some payers ask for them during review.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786693314580\"><h3 class=\"schema-faq-question\">What is the difference between CPT 23472 and CPT 23470?<\/h3> <p class=\"schema-faq-answer\">CPT 23472 requires replacement of both the glenoid and the proximal humeral components. CPT 23470 covers hemi-arthroplasty, where only the humeral head is replaced and the native glenoid stays. The operative report determines which code applies. Billing 23472 when only the humeral component was replaced is upcoding, whatever the surgeon intended.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786693314581\"><h3 class=\"schema-faq-question\">What documentation is required to bill CPT code 23472?<\/h3> <p class=\"schema-faq-answer\">You need a pre-authorization packet with the qualifying ICD-10 diagnosis and evidence of failed conservative treatment. The operative report has to confirm that both components were implanted, with the implant manufacturer and lot number. Post-operative documentation then has to account for the 90-day global period.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786693314582\"><h3 class=\"schema-faq-question\">What are the RVU values for CPT code 23472?<\/h3> <p class=\"schema-faq-answer\">CPT 23472 carries 21.58 work RVUs, 12.99 practice expense RVUs, and 4.36 malpractice RVUs in 2026. That totals 38.93 RVUs, and CMS lists the same values for facility and non-facility settings. Multiply the total by the 2026 conversion factor of $33.4009, or $33.5675 for qualifying APM participants, for the pre-GPCI national amount.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786693314583\"><h3 class=\"schema-faq-question\">Is CPT 23472 covered by Medicare?<\/h3> <p class=\"schema-faq-answer\">Yes, Medicare covers CPT 23472 when medical necessity is documented and the case meets the LCD criteria for your MAC jurisdiction. Pre-authorization requirements vary by payer. Medicare itself does not universally require prior authorization for total shoulder arthroplasty, but many Medicare Advantage plans do. Verify the requirement with the patient&rsquo;s plan before the procedure date.<\/p> <\/div> <\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>CPT 23472 covers total shoulder arthroplasty, both components. Medicare pays about $1,300 in 2026, and LT or RT is mandatory.<\/p>\n","protected":false},"author":82,"featured_media":180119,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"80","_yoast_wpseo_content_score":"30","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1546],"tags":[1162,1602,1163,2395,1063],"class_list":["post-180120","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-cpt-codes","tag-cpt-codes","tag-cpt-modifiers","tag-medical-billing","tag-medicare-billing","tag-posts-us"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>CPT code 23472: 2026 Medicare rate, RVUs, and modifiers<\/title>\n<meta name=\"description\" content=\"CPT 23472 covers total shoulder arthroplasty, both components. Medicare pays about $1,300 in 2026, and LT or RT is mandatory.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-23472\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CPT code 23472: 2026 Medicare rate, RVUs, and modifiers\" \/>\n<meta property=\"og:description\" content=\"CPT 23472 covers total shoulder arthroplasty, both components. Medicare pays about $1,300 in 2026, and LT or RT is mandatory.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-23472\/\" \/>\n<meta property=\"og:site_name\" content=\"Pabau\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/Pabau\/\" \/>\n<meta property=\"article:published_time\" content=\"2026-08-14T08:38:26+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-14T08:59:29+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/08\/cpt-code-23472.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"630\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Maja Popovska\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:site\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:label1\" content=\"\u00c9crit par\" \/>\n\t<meta name=\"twitter:data1\" content=\"Maja Popovska\" \/>\n\t<meta name=\"twitter:label2\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data2\" content=\"11 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/\"},\"author\":{\"name\":\"Maja Popovska\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/#\\\/schema\\\/person\\\/b00aec1dd379f0ddcf6137d78e2a21db\"},\"headline\":\"CPT code 23472: Total shoulder arthroplasty billing guide\",\"datePublished\":\"2026-08-14T08:38:26+00:00\",\"dateModified\":\"2026-08-14T08:59:29+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/\"},\"wordCount\":2184,\"publisher\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/cpt-code-23472.webp\",\"keywords\":[\"CPT Codes\",\"Cpt Modifiers\",\"Medical Billing\",\"Medicare Billing\",\"posts-us\"],\"articleSection\":[\"Billing Codes\",\"CPT Codes\"],\"inLanguage\":\"fr-FR\"},{\"@type\":[\"WebPage\",\"FAQPage\"],\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/\",\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/\",\"name\":\"CPT code 23472: 2026 Medicare rate, RVUs, and modifiers\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/cpt-code-23472.webp\",\"datePublished\":\"2026-08-14T08:38:26+00:00\",\"dateModified\":\"2026-08-14T08:59:29+00:00\",\"description\":\"CPT 23472 covers total shoulder arthroplasty, both components. 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It combines scheduling, electronic health records, clinical forms, payments, marketing automation, reporting, and patient engagement tools into one secure cloud system to help practices streamline operations and grow their business.\",\"foundingDate\":\"2011-10-20\",\"numberOfEmployees\":{\"@type\":\"QuantitativeValue\",\"minValue\":\"201\",\"maxValue\":\"500\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/#\\\/schema\\\/person\\\/b00aec1dd379f0ddcf6137d78e2a21db\",\"name\":\"Maja Popovska\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-Maja-Popovska_WP-1-96x96.jpeg\",\"url\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-Maja-Popovska_WP-1-96x96.jpeg\",\"contentUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-Maja-Popovska_WP-1-96x96.jpeg\",\"caption\":\"Maja Popovska\"},\"description\":\"Maja is a Senior Content Writer at Pabau, where she covers everything from practice management and compliance to medical aesthetics and patient experience. Off the clock: binging true crime docuseries, baking and dreaming about travel.\",\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/blog\\\/author\\\/maja-popovska\\\/\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/#faq-question-1786693314577\",\"position\":1,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/#faq-question-1786693314577\",\"name\":\"What does CPT code 23472 cover?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT code 23472 covers total shoulder arthroplasty, the surgical replacement of both the glenoid socket and the proximal humeral ball. It does not apply when only one component is replaced. Use 23470 for hemi-arthroplasty, and 23473 or 23474 for revision procedures.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/#faq-question-1786693314578\",\"position\":2,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/#faq-question-1786693314578\",\"name\":\"What is the Medicare reimbursement rate for CPT 23472?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"The 2026 Medicare national unadjusted rate is about $1,300 for the physician professional fee. That figure is 38.93 total RVUs multiplied by the $33.4009 conversion factor. Geographic Practice Cost Index (GPCI) adjustments move actual payment by locality. Check the CMS fee schedule look-up tool for your MAC before you quote a number.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/#faq-question-1786693314579\",\"position\":3,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/#faq-question-1786693314579\",\"name\":\"What modifiers are used with CPT code 23472?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"LT for the left side or RT for the right side is mandatory on every 23472 claim. Modifier 22 applies when the case took substantially more work than usual, supported by detailed operative documentation. Modifier 59 marks a distinct procedural service and overrides applicable NCCI bundling edits. Modifier 78 covers an unplanned return to the operating room during the 90-day global period.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/#faq-question-1786693314584\",\"position\":4,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/#faq-question-1786693314584\",\"name\":\"Does CPT 23472 cover reverse total shoulder arthroplasty?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Yes. CPT has no separate entry for the reverse configuration, so 23472 reports both anatomic and reverse total shoulder arthroplasty. Record the configuration and the implant details in the operative note anyway, because some payers ask for them during review.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/#faq-question-1786693314580\",\"position\":5,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/#faq-question-1786693314580\",\"name\":\"What is the difference between CPT 23472 and CPT 23470?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT 23472 requires replacement of both the glenoid and the proximal humeral components. CPT 23470 covers hemi-arthroplasty, where only the humeral head is replaced and the native glenoid stays. The operative report determines which code applies. Billing 23472 when only the humeral component was replaced is upcoding, whatever the surgeon intended.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/#faq-question-1786693314581\",\"position\":6,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/#faq-question-1786693314581\",\"name\":\"What documentation is required to bill CPT code 23472?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"You need a pre-authorization packet with the qualifying ICD-10 diagnosis and evidence of failed conservative treatment. The operative report has to confirm that both components were implanted, with the implant manufacturer and lot number. Post-operative documentation then has to account for the 90-day global period.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/#faq-question-1786693314582\",\"position\":7,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/#faq-question-1786693314582\",\"name\":\"What are the RVU values for CPT code 23472?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT 23472 carries 21.58 work RVUs, 12.99 practice expense RVUs, and 4.36 malpractice RVUs in 2026. That totals 38.93 RVUs, and CMS lists the same values for facility and non-facility settings. Multiply the total by the 2026 conversion factor of $33.4009, or $33.5675 for qualifying APM participants, for the pre-GPCI national amount.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/#faq-question-1786693314583\",\"position\":8,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-23472\\\/#faq-question-1786693314583\",\"name\":\"Is CPT 23472 covered by Medicare?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Yes, Medicare covers CPT 23472 when medical necessity is documented and the case meets the LCD criteria for your MAC jurisdiction. Pre-authorization requirements vary by payer. Medicare itself does not universally require prior authorization for total shoulder arthroplasty, but many Medicare Advantage plans do. Verify the requirement with the patient's plan before the procedure date.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"}]}<\/script>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"CPT code 23472: 2026 Medicare rate, RVUs, and modifiers","description":"CPT 23472 covers total shoulder arthroplasty, both components. Medicare pays about $1,300 in 2026, and LT or RT is mandatory.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-23472\/","og_locale":"fr_FR","og_type":"article","og_title":"CPT code 23472: 2026 Medicare rate, RVUs, and modifiers","og_description":"CPT 23472 covers total shoulder arthroplasty, both components. 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Off the clock: binging true crime docuseries, baking and dreaming about travel.","url":"https:\/\/pabau.com\/fr\/blog\/author\/maja-popovska\/"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-23472\/#faq-question-1786693314577","position":1,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-23472\/#faq-question-1786693314577","name":"What does CPT code 23472 cover?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT code 23472 covers total shoulder arthroplasty, the surgical replacement of both the glenoid socket and the proximal humeral ball. It does not apply when only one component is replaced. Use 23470 for hemi-arthroplasty, and 23473 or 23474 for revision procedures.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-23472\/#faq-question-1786693314578","position":2,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-23472\/#faq-question-1786693314578","name":"What is the Medicare reimbursement rate for CPT 23472?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"The 2026 Medicare national unadjusted rate is about $1,300 for the physician professional fee. That figure is 38.93 total RVUs multiplied by the $33.4009 conversion factor. Geographic Practice Cost Index (GPCI) adjustments move actual payment by locality. Check the CMS fee schedule look-up tool for your MAC before you quote a number.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-23472\/#faq-question-1786693314579","position":3,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-23472\/#faq-question-1786693314579","name":"What modifiers are used with CPT code 23472?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"LT for the left side or RT for the right side is mandatory on every 23472 claim. Modifier 22 applies when the case took substantially more work than usual, supported by detailed operative documentation. Modifier 59 marks a distinct procedural service and overrides applicable NCCI bundling edits. Modifier 78 covers an unplanned return to the operating room during the 90-day global period.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-23472\/#faq-question-1786693314584","position":4,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-23472\/#faq-question-1786693314584","name":"Does CPT 23472 cover reverse total shoulder arthroplasty?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Yes. CPT has no separate entry for the reverse configuration, so 23472 reports both anatomic and reverse total shoulder arthroplasty. Record the configuration and the implant details in the operative note anyway, because some payers ask for them during review.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-23472\/#faq-question-1786693314580","position":5,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-23472\/#faq-question-1786693314580","name":"What is the difference between CPT 23472 and CPT 23470?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT 23472 requires replacement of both the glenoid and the proximal humeral components. CPT 23470 covers hemi-arthroplasty, where only the humeral head is replaced and the native glenoid stays. The operative report determines which code applies. Billing 23472 when only the humeral component was replaced is upcoding, whatever the surgeon intended.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-23472\/#faq-question-1786693314581","position":6,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-23472\/#faq-question-1786693314581","name":"What documentation is required to bill CPT code 23472?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"You need a pre-authorization packet with the qualifying ICD-10 diagnosis and evidence of failed conservative treatment. The operative report has to confirm that both components were implanted, with the implant manufacturer and lot number. Post-operative documentation then has to account for the 90-day global period.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-23472\/#faq-question-1786693314582","position":7,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-23472\/#faq-question-1786693314582","name":"What are the RVU values for CPT code 23472?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT 23472 carries 21.58 work RVUs, 12.99 practice expense RVUs, and 4.36 malpractice RVUs in 2026. That totals 38.93 RVUs, and CMS lists the same values for facility and non-facility settings. Multiply the total by the 2026 conversion factor of $33.4009, or $33.5675 for qualifying APM participants, for the pre-GPCI national amount.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-23472\/#faq-question-1786693314583","position":8,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-23472\/#faq-question-1786693314583","name":"Is CPT 23472 covered by Medicare?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Yes, Medicare covers CPT 23472 when medical necessity is documented and the case meets the LCD criteria for your MAC jurisdiction. Pre-authorization requirements vary by payer. Medicare itself does not universally require prior authorization for total shoulder arthroplasty, but many Medicare Advantage plans do. Verify the requirement with the patient's plan before the procedure date.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"}]}},"yoast":{"focus_keyword":"CPT code 23472","seo_title":"CPT code 23472: 2026 Medicare rate, RVUs, and modifiers","meta_description":"CPT 23472 covers total shoulder arthroplasty, both components. 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