Shoulder Arthroplasty CPT Coding 2026: The Complete Guide to Total, Reverse, Hemi, and Revision Codes (23470 to 23474)

Shoulder arthroplasty is coded with four primary CPT codes: 23470 for hemiarthroplasty, 23472 for total shoulder arthroplasty (which covers both anatomic and reverse total shoulder replacement), 23473 for revision of one component (humeral or glenoid), and 23474 for revision of both components. Acute proximal humerus fractures treated with a humeral prosthesis are coded separately with 23616. All of these procedures carry a 90-day global period, require an RT or LT modifier, and must be paired with a specific ICD-10-CM diagnosis such as primary glenohumeral osteoarthritis (M19.011, M19.012), rotator cuff tear arthropathy (M12.81-), or a prosthetic joint complication code in the T84 category for revisions.

The coding rules look simple, but shoulder arthroplasty is one of the highest-value procedures an orthopaedic practice bills, and small mistakes are expensive. The CY2027 Physician Fee Schedule proposed rule would reduce work RVUs for total shoulder arthroplasty by about 19% and for hemiarthroplasty by about 21%. With less margin per case, every missed modifier, bundled service billed separately, or revision coded as a primary procedure costs more than it used to.

This guide covers every shoulder arthroplasty code, the fracture and revision scenarios that cause the most confusion, bundling rules, modifiers, ICD-10 pairing, documentation requirements, and site-of-service considerations for 2026.

The Shoulder Arthroplasty CPT Codes

23470: Hemiarthroplasty

CPT 23470 describes arthroplasty of the glenohumeral joint with hemiarthroplasty: replacement of the humeral head only, with no glenoid component. Hemiarthroplasty is now less common for arthritis than total or reverse shoulder replacement, but it is still used for select patients, including some younger patients with intact glenoid cartilage, some cases of avascular necrosis, and some fracture patterns.

Do not use 23470 for a hemiarthroplasty performed for an acute proximal humerus fracture. That scenario is coded with 23616 (see the fracture section below).

23472: Total Shoulder Arthroplasty (Anatomic and Reverse)

CPT 23472 describes arthroplasty of the glenohumeral joint, total shoulder, with glenoid and proximal humeral replacement. The most common coding question about shoulder arthroplasty has a simple answer: CPT does not have a separate code for reverse total shoulder arthroplasty. Anatomic total shoulder arthroplasty, reverse total shoulder arthroplasty, and stemless total shoulder arthroplasty are all reported with 23472.

That makes documentation more important, not less. Payers, registries, and implant tracking all need to know which construct was used. The operative note should state clearly whether the procedure was an anatomic or reverse arthroplasty, identify the implants, and describe the indication. Commercial payer medical policies often apply different criteria to reverse arthroplasty (for example, requiring documentation of rotator cuff deficiency), and a prior authorization request should specify the construct even though the CPT code is the same.

23473: Revision of Total Shoulder Arthroplasty, One Component

CPT 23473 describes revision of a total shoulder arthroplasty, including allograft when performed, of the humeral or glenoid component. Use it when one component is revised and the other is retained.

23474: Revision of Total Shoulder Arthroplasty, Both Components

CPT 23474 describes revision of a total shoulder arthroplasty, including allograft when performed, of both the humeral and glenoid components. A common example is revision of a failed anatomic total shoulder to a reverse total shoulder, which typically requires changing both components.

Because allograft is included in the descriptors for 23473 and 23474, structural or morselized allograft used during a revision is not reported separately.

23616: Proximal Humerus Fracture With Prosthetic Replacement

CPT 23616 describes open treatment of a proximal humeral fracture, including internal fixation when performed and repair of the tuberosities, with proximal humeral prosthetic replacement. It is the code for hemiarthroplasty performed to treat an acute fracture.

23334 and 23335: Prosthesis Removal

CPT 23334 describes removal of a shoulder prosthesis, including debridement and synovectomy when performed, of the humeral or glenoid component. CPT 23335 describes removal of both components. These codes are used most often in the first stage of a two-stage revision for periprosthetic infection, when implants are removed and reimplantation is planned for a later date.

Coding Reverse Shoulder Arthroplasty for Acute Fractures

Reverse total shoulder arthroplasty has become a common treatment for complex proximal humerus fractures in older patients. The coding question is whether to report 23616, which describes fracture treatment with a proximal humeral prosthesis and includes tuberosity repair, or 23472, which describes a total shoulder with both glenoid and humeral replacement.

Coding references have not always agreed. Because a reverse arthroplasty replaces the glenoid side as well as the humeral side, many coders report 23472 for reverse arthroplasty performed for fracture, with the fracture diagnosis as the primary ICD-10 code. Others point to 23616's inclusion of fracture treatment and tuberosity repair. The right answer for your practice should be based on the most current CPT Assistant guidance and each payer's policy, and it should be applied consistently. Whichever code you use, do not report both 23616 and 23472 for the same shoulder, and make sure the operative note documents the fracture pattern, the glenoid work, and the tuberosity management.

Coding Revisions, Conversions, and Staged Procedures

Revision coding is where the largest dollar errors happen, because revision codes carry more RVUs than primary codes and payers scrutinize them closely.

One component or two?

The operative note must state which components were revised and which were retained. "Revision of total shoulder" without that detail forces the coder to guess or query. Revising the glenoid only, such as for glenoid loosening, is 23473. Revising both, such as converting an anatomic total to a reverse, is 23474. Exchanging a modular humeral head or polyethylene insert alone should be reviewed carefully against the CPT descriptor and payer guidance, because payers may challenge a revision code when the work was limited.

Converting a hemiarthroplasty to a total or reverse shoulder

When a surgeon converts a prior hemiarthroplasty to a total or reverse shoulder arthroplasty, the correct code depends on how the work is characterized. Some coding guidance supports a revision code because a prior prosthesis is being revised; other guidance treats the procedure as a total shoulder arthroplasty because the prior implant was not a total shoulder. This is another area to confirm with current CPT Assistant guidance and payer policy, and to document thoroughly: the prior implant, which components were removed or retained, and the additional work compared with a primary arthroplasty.

Two-stage revision for infection

A two-stage revision typically involves removal of the implants with debridement and placement of an antibiotic spacer at the first stage (23334 or 23335), then reimplantation at the second stage. The second stage is usually coded with the appropriate arthroplasty code. When the second stage occurs during the global period of the first, append modifier 58 to indicate a planned, staged procedure. That starts a new 90-day global period and pays the full fee.

What Is Bundled Into Shoulder Arthroplasty

Many procedures that happen during shoulder arthroplasty are considered part of the primary procedure and are not reported separately. Under NCCI procedure-to-procedure edits and CPT surgical package rules, the following are generally bundled when performed on the same shoulder through the same approach:

• Arthrotomy, exposure, and closure
• Debridement and synovectomy
• Capsular release
• Subscapularis takedown and repair (or lesser tuberosity osteotomy and repair)
• Biceps tenotomy, and in many cases biceps tenodesis
• Removal of osteophytes and loose bodies
• Local bone graft harvested from the humeral head or surgical site
• Intraoperative fluoroscopy performed by the surgeon

Other procedures may be separately reportable in specific circumstances, but they are frequent audit targets. Examples include a rotator cuff repair performed with a hemiarthroplasty, a latissimus dorsi or lower trapezius tendon transfer performed with a reverse arthroplasty, removal of deep hardware from a prior fracture fixation, and autograft harvested through a separate incision (such as iliac crest bone graft, reported with 20902). Check current NCCI edits before billing any additional code with 23472, and use modifier 59 or the X modifiers only when the documentation clearly supports a distinct procedure. Note that bone graft codes 20930 to 20939 are reserved for spine surgery and are not reported with shoulder arthroplasty.

Modifiers for Shoulder Arthroplasty

RT and LT

Every shoulder arthroplasty claim should carry the correct laterality modifier. The laterality in the diagnosis code should match. Mismatched laterality is one of the most avoidable denials in orthopaedics.

Modifier 22: Increased procedural services

Modifier 22 applies when the work required is substantially greater than typically required for the procedure. In shoulder arthroplasty, examples may include severe glenoid bone loss requiring structural grafting or augmented components, extensive scarring from multiple prior surgeries, or significant deformity. Modifier 22 claims are reviewed manually, so the operative note must explain what made the case unusual and, ideally, quantify the additional time and effort compared with a typical case. Modifier 22 should not be used for revisions simply because they are revisions; 23473 and 23474 already account for that work.

Modifiers 80, 82, and AS: Assistants at surgery

Shoulder arthroplasty frequently involves an assistant. Use 80 for a physician assistant at surgery, 82 when a qualified resident is not available (in teaching settings), and AS for a PA, NP, or clinical nurse specialist assisting. Check the Medicare Physician Fee Schedule assistant-at-surgery indicator for each code and each commercial payer's policy before billing.

Modifier 62: Co-surgeons

Modifier 62 applies when two surgeons of different specialties each perform distinct parts of a single procedure. It is uncommon in routine shoulder arthroplasty but can apply in complex reconstruction cases. Both surgeons must document their portion.

Global period modifiers: 57, 24, 78, 79, 58

• 57: Append to the E&M visit on the day of or day before surgery when that visit resulted in the decision to operate.
• 24: Append to an unrelated E&M visit during the 90-day postoperative period.
• 78: Append to an unplanned return to the operating room for a related complication during the global period, such as an open reduction of a dislocated prosthesis. Payment is limited to the intraoperative portion, and no new global period begins.
• 79: Append to an unrelated procedure during the global period, such as surgery on the opposite shoulder.
• 58: Append to a planned or staged procedure during the global period, such as the second stage of a two-stage revision.

A dislocated prosthesis during the global period is a related complication. Under Medicare's global surgery rules, treatment is separately payable with modifier 78 only when it requires a return to the operating room, so review payer rules before billing an office or emergency department closed reduction.

ICD-10-CM Pairing for Shoulder Arthroplasty

The diagnosis code tells the payer why the shoulder was replaced. Specificity matters for medical necessity, for revision payment, and for registry reporting.

Primary arthroplasty diagnoses

• Primary osteoarthritis of the shoulder: M19.011 (right), M19.012 (left)
• Post-traumatic osteoarthritis of the shoulder: M19.111 (right), M19.112 (left)
• Other secondary osteoarthritis of the shoulder: M19.211 (right), M19.212 (left)
• Rotator cuff tear arthropathy: M12.811 (right), M12.812 (left), typically reported with the appropriate rotator cuff tear code from M75.1- when the tear is documented
• Avascular necrosis of the humeral head: M87.021 (right), M87.022 (left) for idiopathic aseptic necrosis; other M87 subcategories apply for secondary causes
• Rheumatoid arthritis of the shoulder: codes from M05 or M06 with shoulder site specificity
• Acute proximal humerus fracture: codes from S42.2- with the correct seventh character (A for initial encounter)

For reverse arthroplasty, payers often want to see rotator cuff deficiency documented. If the surgeon documents a massive irreparable rotator cuff tear with arthropathy, code the arthropathy and the tear, not just osteoarthritis.

Revision diagnoses

Revisions are coded with complications of internal prosthetic devices in category T84, using the "other internal prosthetic joint" subcodes for the shoulder, plus the seventh character A for the initial encounter:

• Broken internal joint prosthesis: T84.018A
• Dislocation (instability) of internal joint prosthesis: T84.028A
• Mechanical loosening: T84.038A
• Periprosthetic osteolysis: T84.058A
• Wear of articular bearing surface: T84.068A
• Other mechanical complication: T84.098A
• Infection and inflammatory reaction: T84.59XA, with an additional code for the organism when known
• Periprosthetic fracture around a shoulder prosthesis: M97.31XA (right), M97.32XA (left)

A revision billed with a primary osteoarthritis code is a red flag for payers. The diagnosis must explain why the existing prosthesis failed.

Documentation That Supports Shoulder Arthroplasty Payment

Payers and auditors look for the same documentation elements across most shoulder arthroplasty claims.

‍For medical necessity (usually reviewed at prior authorization):

• Imaging findings showing advanced glenohumeral arthritis, cuff tear arthropathy, avascular necrosis, or fracture
• Duration and type of failed conservative treatment, such as physical therapy, injections, NSAIDs, and activity modification, for elective cases
• Functional limitations, including range of motion deficits and effects on daily activities, sleep, and work
• For reverse arthroplasty, evidence of rotator cuff deficiency or other indications named in the payer's policy

‍For coding accuracy (reviewed at claim submission and audit):

• Anatomic, reverse, or stemless construct clearly stated
• Implants used, including augmented components or structural grafts
• For revisions, the prior implant, the reason for failure, and exactly which components were removed, revised, and retained
• Any additional procedures performed, with a separate description of the work and its indication
• For modifier 22, a specific explanation of the unusual work and its effect on time and difficulty

Site of Service: Shoulder Arthroplasty in the ASC

The site-of-service shift for shoulder arthroplasty has been fast. CMS removed total shoulder arthroplasty (23472) from the inpatient-only list in 2021 and added it to the ASC covered procedures list in 2024. According to a 2026 MedScout analysis of Medicare claims, the ASC share of total shoulder arthroplasty rose from 6.4% before ASC eligibility to more than 30% by 2025.

For professional billing, the surgeon's CPT code does not change with the setting, but several things do:

• Place of service: POS 24 for an ASC, POS 22 for hospital outpatient, POS 21 for inpatient. The claim must match where the case was performed.
• Prior authorization: Many payers authorize a specific site of service. A case authorized for hospital outpatient that moves to the ASC needs an updated authorization.
• Payment: Surgeon payment for 23472 uses facility RVUs in all three settings, but facility and implant payment differ significantly, which matters for groups with ASC ownership.

What the 2027 Fee Schedule Proposal Means for Shoulder Arthroplasty

The CY2027 Physician Fee Schedule proposed rule, released July 14, 2026, projects a 7% aggregate reduction for orthopaedic surgery. Major joint procedures take the largest share of that cut: the proposed work RVU changes include reductions of about 19% for total shoulder arthroplasty and about 21% for shoulder hemiarthroplasty. The proposed conversion factor for clinicians who are not qualifying APM participants is $32.84, down 1.68% from 2026.

The final rule, expected in early November 2026, will determine the actual figures. Either way, the direction is clear: reimbursement per shoulder arthroplasty is falling, which raises the cost of every coding error. Practices should model the impact by surgeon and review revision coding, modifier 22 use, and assistant-at-surgery billing, where undercoding is common.

Common Shoulder Arthroplasty Coding Errors

1. Looking for a reverse shoulder code. There isn't one. Reverse total shoulder arthroplasty is 23472.
2. Coding a fracture hemiarthroplasty as 23470. Acute fracture treatment with a humeral prosthesis is 23616.
3. Coding a revision as a primary procedure. When a prior arthroplasty is revised, use 23473 or 23474 and a T84 diagnosis, not 23472 with an osteoarthritis code.
4. Reporting bundled soft tissue procedures separately. Subscapularis repair, capsular release, and debridement are part of the arthroplasty.
5. Billing allograft with a revision. Allograft is included in 23473 and 23474.
6. Missing or mismatched laterality. The RT or LT modifier and the ICD-10 laterality must agree.
7. Forgetting modifier 58 on a staged second stage. Without it, the reimplantation may be denied as part of the first stage's global period.
8. Undocumented modifier 22. Without a clear explanation, the claim will be paid at the standard rate or denied.

How AI Coding Helps With Shoulder Arthroplasty

Shoulder arthroplasty coding depends on reading the operative note carefully: which construct, which components, which additional procedures, and why. That is exactly what an orthopaedic-specific AI coder is built to do.

Maia's Surgical AutoCoder reads the operative note inside the EHR and recommends the CPT codes, modifiers, and ICD-10 codes with clinical justification before a coder reviews the case. It distinguishes primary from revision procedures, flags documentation gaps such as an unstated construct or unclear component revision, identifies bundling conflicts, and checks laterality. Maia reports a 50% efficiency gain on surgical coding and a 1 to 5% revenue lift for orthopaedic practices. Groups use Maia inside Athena, eClinicalWorks and coming soon: Epic, ModMed, NextGen, and Tebra.

Frequently Asked Questions

What is the CPT code for reverse total shoulder arthroplasty?

Reverse total shoulder arthroplasty is reported with CPT 23472, the same code used for anatomic total shoulder arthroplasty. CPT does not have a separate code for reverse arthroplasty, so the operative note should clearly document which construct was used.

What is the difference between CPT 23473 and 23474?

CPT 23473 is revision of a total shoulder arthroplasty involving one component, either the humeral or glenoid component. CPT 23474 is revision involving both components. Both include allograft when performed.

How do you code a hemiarthroplasty for a proximal humerus fracture?

Hemiarthroplasty for an acute proximal humerus fracture is coded with CPT 23616, open treatment of a proximal humeral fracture with proximal humeral prosthetic replacement. CPT 23470 is used for hemiarthroplasty performed for other indications, such as arthritis or avascular necrosis.

What is the global period for shoulder arthroplasty?

Shoulder arthroplasty codes 23470, 23472, 23473, 23474, and 23616 carry a 90-day global period. Related postoperative care during that period is included in the surgical payment.

What ICD-10 code is used for a shoulder arthroplasty revision?

Revisions are coded with complications of internal joint prostheses in category T84, using the "other internal prosthetic joint" subcodes for the shoulder. Examples include T84.038A for mechanical loosening, T84.028A for dislocation, and T84.59XA for infection. Periprosthetic fractures around a shoulder prosthesis are coded M97.31XA (right) or M97.32XA (left).

Can biceps tenodesis be billed with total shoulder arthroplasty?

In most cases, biceps tenotomy or tenodesis performed on the same shoulder during arthroplasty is bundled into the arthroplasty under NCCI edits. Check current NCCI procedure-to-procedure edits and payer policy before billing it separately, and bill it only when documentation supports a distinct procedure.

Is total shoulder arthroplasty covered in an ASC by Medicare?

Yes. CMS added total shoulder arthroplasty (CPT 23472) to the ASC covered procedures list in 2024. The ASC share of Medicare total shoulder arthroplasty rose to more than 30% by 2025.

See how Maia's AutoCoder handles this for orthopaedic practices. Book a demo at usemaia.com.