CPT 23405
Global 090 ActiveIncision of tendon & muscle
CPT 23405 Billing & Documentation Guide
CPT code 23405 (Incision of tendon & muscle) is classified under Surgery (Musculoskeletal) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 8.33, a non-facility practice expense RVU of 7.31, and a malpractice RVU of 1.56, a total non-facility RVU of 17.2 and facility RVU of 17.2. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $583.33, though rates vary from $514.8 to $706.09 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 23405, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 23405 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 2 units of 23405 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 23405
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 8.33 | 8.33 |
| Practice Expense RVU | 7.31 | 7.31 |
| Malpractice RVU | 1.56 | 1.56 |
| Total RVU | 17.2 | 17.2 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 23405
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $605.37 | $605.37 | $578.49 - $688.84 | 29 |
| Florida | $624.64 | $624.64 | $589.96 - $664.18 | 3 |
| Georgia | $573.92 | $573.92 | $558.13 - $589.71 | 2 |
| Illinois | $614.7 | $614.7 | $582.59 - $645.14 | 4 |
| Michigan | $580.84 | $580.84 | $559.98 - $601.69 | 2 |
| North Carolina | $539.33 | $539.33 | $539.33 - $539.33 | 1 |
| New York | $634.64 | $634.64 | $546.81 - $683.1 | 5 |
| Ohio | $553.67 | $553.67 | $553.67 - $553.67 | 1 |
| Pennsylvania | $575.59 | $575.59 | $551.61 - $599.57 | 2 |
| Texas | $568.53 | $568.53 | $548.82 - $594.6 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 23405
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 23405 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 01610 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01995 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 23405
What does CPT code 23405 mean? +
CPT code 23405 represents: Incision of tendon & muscle. It's in the Surgery (Musculoskeletal) category with a global period of 090.
What is the Medicare reimbursement for CPT 23405? +
The 2026 Medicare national average non-facility payment for CPT 23405 is $583.33. Rates range from $514.8 to $706.09 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 23405? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 23405? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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