CPT code 23462: Reimbursement, RVUs, modifiers, and billing guide

Key takeaways

CPT code 23462 describes an open anterior capsulorrhaphy with coracoid process transfer, the code used for Latarjet and Bristow shoulder stabilization.

The code carries 29.26 total RVUs and pays roughly $977 under Medicare, before your locality adjustment is applied.

Modifier -LT or -RT is required on every claim, and leaving it off is the leading cause of rejection.

Recurrent anterior dislocation is coded M24.411, M24.412, or M24.419, and the laterality must match the modifier on the claim.

Practice management software like Pabau helps orthopedic practices track modifier use and catch coding errors before a claim leaves the building.

CPT code 23462 reports an open anterior capsulorrhaphy with coracoid process transfer. The official long descriptor reads: Capsulorrhaphy, anterior, any type; with coracoid process transfer.

The code belongs to the Musculoskeletal System section of the CPT set, which the American Medical Association (AMA) maintains. Within that section it sits under repair, revision, and reconstruction procedures on the shoulder joint.

Two elements define the code. The first is an anterior capsulorrhaphy, where the surgeon repairs or tightens the anterior joint capsule to reduce the risk of another dislocation.

The second is a coracoid process transfer. The coracoid tip and the conjoined tendon are detached and repositioned to the anterior glenoid rim. That creates a bony and soft-tissue barrier against repeat subluxation.

This combination is the hallmark of the Latarjet and Bristow procedures, both of which fall under 23462.

Several coding references describe CPT 23462 as an arthroscopic rotator cuff repair. That is wrong. CPT 23462 is an open anterior stabilization procedure involving the capsule and the coracoid. Arthroscopic rotator cuff repairs sit in the 29800s range.

Check that the operative report confirms an open approach and a coracoid transfer before you submit this code. Practices using claims management software can flag the distinction during pre-submission review.

Procedure description and clinical indications

CPT 23462 is indicated for recurrent anterior glenohumeral instability. It applies to patients who have failed conservative management, or who have bone loss that makes a soft-tissue-only repair insufficient.

The Latarjet procedure is the most common variant. Surgeons reach for it when glenoid bone loss exceeds 20% to 25%, or in high-risk athletes with engaging Hill-Sachs lesions.

The surgical sequence typically includes:

• Open anterior approach to the glenohumeral joint
• Identification and release of the subscapularis muscle
• Osteotomy of the coracoid process with preservation of the conjoined tendon
• Transfer of the coracoid graft to the anterior glenoid rim with fixation, typically two screws
• Anterior capsulorrhaphy or capsular repair to complete the stabilization

Because the procedure is open and involves a bony transfer, it differs from arthroscopic Bankart repair under 29806. It also differs from capsulorrhaphy alone, without coracoid transfer, under 23455 or 23460.

The operative note must confirm every one of those steps, especially the coracoid osteotomy and the fixation. Orthopedic and sports medicine practices running Latarjet cases should build a documentation checklist into the pre-operative workflow.

CPT code 23462 RVU breakdown

Relative Value Units (RVUs) form the basis of Medicare reimbursement for CPT 23462. The table below reflects 2026 values from the Medicare Physician Fee Schedule. Verify current figures with the CMS Physician Fee Schedule lookup, or with an RVU tool such as FastRVU.

The conversion factor and Geographic Practice Cost Index (GPCI) adjustments mean actual payment varies by locality.

RVU values are updated annually through the Medicare Physician Fee Schedule Final Rule. Confirm the 2026 conversion factor and any RVU adjustments before you bill.

GPCI locality multipliers adjust PE and MP RVUs further. A practice in San Francisco will see different payment than one in rural Mississippi billing the same code.

Reimbursement rates and Medicare fee schedule for CPT 23462

CPT 23462 reimbursement under Medicare is the total RVUs multiplied by the conversion factor, with GPCI adjustments applied. The procedure is almost always performed in a hospital or ambulatory surgery center, so facility rates matter most for physician payment.

Commercial rates for CPT 23462 are negotiated through provider contracts and often exceed Medicare. Most commercial plans require prior authorization before a Latarjet procedure. Document the medical necessity determination and keep the authorization number in the patient record.

Without an authorization tracking workflow, a practice can perform the procedure before coverage is confirmed, which usually ends in a denial. Practice management software features that include authorization tracking reduce that exposure.

Modifiers for CPT code 23462

Modifiers change how a claim is processed without changing what the code means. These are the ones that come up most often on CPT 23462 claims:

Laterality modifiers are mandatory for shoulder procedures. Submitting CPT 23462 without -LT or -RT is one of the most common reasons a clean claim rejects.

Some payers also want modifier -22 when operative time runs well beyond typical, with documentation attached. Confirm modifier requirements with each payer before you submit.

ICD-10 diagnosis codes that support CPT 23462

Medical necessity for CPT 23462 has to be established with an appropriate ICD-10-CM diagnosis code. The table below lists the codes most often linked to anterior shoulder instability procedures.

Payer LCD policies vary, so verify coverage with the specific plan. CrossCoder and the AAPC CPT lookup both cross-reference current crosswalk data.

Specificity matters. M24.411 and M24.412 are preferred over M24.419, because laterality-specific codes reduce audit risk and line up with the modifier on the CPT claim.

Not every shoulder girdle code supports this procedure. S43.121S and S43.312S both describe sequelae elsewhere in the shoulder girdle, and neither one supports a coracoid transfer claim.

Practices with a high volume of shoulder instability cases benefit from standardized digital intake forms. Capturing laterality and prior treatment history at consultation creates a documentation trail that runs from assessment to claim.

NCCI bundling edits and unbundling rules

The National Correct Coding Initiative (NCCI) bundles certain procedure codes with CPT 23462. Billing a bundled code alongside 23462 without a qualifying modifier triggers an automatic denial. NCCI edits are updated quarterly, so verify current pairs before you submit a complex shoulder claim.

Codes commonly bundled with CPT 23462 include:

• 23455 covers anterior capsulorrhaphy with labral repair, the open Bankart procedure. There is no coracoid transfer, so it is typically not billable with 23462
• 23460 covers anterior capsulorrhaphy with a bone block. Choose the code that matches the documented technique, not both
• 29806 is arthroscopic Bankart repair, and it cannot be reported with the open 23462 for the same shoulder in the same session
• Evaluation and management (E/M) services on the day of surgery are bundled into the global period when they relate to the procedure

A separate, distinct procedure that does not overlap with the work of CPT 23462 can be unbundled. Use modifier -59, or one of the XS, XE, XP, and XU modifiers.

Support it with a clear statement in the operative note naming the separate anatomical site or indication. An NCCI review step in the submission workflow catches these pairs before the claim reaches the payer.

Documentation requirements for billing CPT 23462

Insufficient operative documentation is the main reason CPT 23462 claims fail on audit. Every element of the procedure has to appear in the operative report, not be inferred from the diagnosis code.

• Approach: Confirm an open anterior approach, not arthroscopic
• Anatomy addressed: Name the coracoid process, conjoined tendon, and anterior glenoid rim explicitly
• Osteotomy and transfer: Describe the coracoid osteotomy technique and the method of fixation, such as two cortical screws
• Capsulorrhaphy: Document the anterior capsule repair or imbrication separately from the bony transfer
• Medical necessity: Reference pre-operative imaging showing glenoid bone loss or a failed prior repair
• Pre-authorization number: Include it in the claim when the commercial payer requires one
• Laterality: State right or left shoulder in both the diagnosis and the operative note
• ICD-10 linkage: The diagnosis on the claim must match the clinical documentation

Practices with high surgical volumes often use structured clinical records so operative note templates capture every required element. A templated note cuts transcription time and the risk of leaving out a billable detail.

Incomplete records also create exposure during commercial payer audits and Medicare Advantage post-payment reviews.

Common billing errors and how to avoid them

Shoulder surgery coding produces predictable error patterns. Knowing where other practices go wrong is a practical way to bring down your own denial rate on CPT 23462.

The most expensive error is coding 23462 when the operative report describes an arthroscopic Bankart repair. The two procedures carry different RVUs and fall under different NCCI rules. Read the approach description first. If it says arthroscopic, 23462 does not apply.

Denial management costs staff time on top of the delayed payment. HIPAA-compliant clinical documentation workflows built into your software stack lower both the audit risk and that administrative cost.

Global period for CPT 23462

CPT 23462 carries a 90-day global period under Medicare, the same as other major surgical procedures. The Medicare fee for 23462 therefore includes routine post-operative care for 90 days after the surgery date.

Services included in the 90-day global period, and therefore not separately billable without a modifier:

• Post-operative office visits related to the shoulder procedure, typically one to three during recovery
• Routine dressing changes and suture removal
• Post-operative pain management directly related to the procedure

Online digital E/M services, such as 99421, also fall inside the global period when they relate to the shoulder procedure.

Services that can be billed separately during the global period:

• Physical therapy or occupational therapy, billed by the treating therapist rather than the surgeon
• Unrelated E/M visits, using modifier -24
• New or unrelated problems requiring separate evaluation, using modifier -25 on the E/M
• Return to the OR for complications, using modifier -78 on the subsequent procedure

Physical therapy ordered after a Latarjet is a common source of global period confusion. The therapist bills independently, and the surgeon does not add therapy codes to the global bundle. Physical therapy EMR platforms that integrate with practice management software make it clear which services belong on which provider’s claim.

Check the current global period indicator for 23462 in the CMS MPFS lookup tool, since indicators can change with annual rule updates.

Related CPT codes: 23455, 23460, and 23472

Coders working anterior shoulder instability cases need to separate CPT 23462 from adjacent codes in the same family. The choice depends on what the operative report documents, not on the diagnosis.

The pairing most often confused is 23460 versus 23462. Both add bone to the anterior glenoid, but the source of that bone differs. If the surgeon harvested iliac crest or another graft site, 23460 applies. If the surgeon transferred the patient’s own coracoid with the conjoined tendon attached, 23462 is correct.

The same logic runs through the rest of the 23000 shoulder series, including 23073. Comparing operative reports against each other is a useful quality step when you audit private practice EHR documentation.

How Pabau supports orthopedic billing accuracy

Orthopedic practices billing complex shoulder procedures carry a documentation burden that grows with case volume. One missed modifier or one incomplete operative note turns a correctly performed procedure into a denied claim.

Today most of that checking happens by hand, with a biller reading each operative note against the claim before it goes out. Practice management software like Pabau moves the check into the record itself, so modifier requirements, authorization numbers, and ICD-10 linkage are verified before submission.

Consultation notes are the other weak point. Pabau Scribe, our AI scribe, drafts the note as the consultation happens. Laterality, prior treatment, and imaging findings are captured as they are said.

Compliance management tools keep the audit trail in one place, so a payer records request does not become a week of file hunting. The result is a continuous documentation trail from the first consultation to the submitted claim.

Reduce orthopedic billing errors before they reach the payer

Pabau’s claims management tools help surgical practices track modifier requirements, authorization status, and documentation completeness across every CPT code, including complex shoulder reconstruction procedures.

Book a demo

Conclusion

CPT 23462 is a narrow code with a wide margin for error. The approach, the coracoid osteotomy, the laterality modifier, and the ICD-10 link all have to agree with each other.

Handle those four consistently and 23462 stops being a denial risk. Handle them case by case and you pay for it in appeals, staff hours, and delayed payment. That is an expensive outcome for a procedure the surgeon already performed correctly.

The trade-off worth remembering is that the checking has to happen before submission, not after the denial. Book a demo to see how Pabau builds those checks into shoulder and musculoskeletal billing workflows.

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