Did you know that shoulder arthroscopy is the second-most common surgical procedure in orthopedic practices? The procedure is used to treat several shoulder ailments, including torn rotator cuffs.
CPT code 29827 is a frequently used shoulder arthroscopy code. Given its importance and high reimbursement amount, we have decided to include this code in our “CPT Codes” series. By the end of this blog, you will have all the information required to bill this code correctly.
CPT Code 29827 – Description
CPT code 29827 is defined as:
“Arthroscopy, shoulder, surgical; with rotator cuff repair.”
Although the definition is quite straightforward and self-explanatory, let’s break it down into simpler words.
CPT code 29827 represents a minimally invasive orthopedic surgical procedure. The surgeon performs arthroscopy to repair torn or damaged rotator cuff tendons within the shoulder joint.
An important point to note here is that 29827 encompasses the repair of one, two, or three rotator cuff tendons during a single surgical session, regardless of the number of arthroscopic portals created. So, if during the surgery more than one tendon needs repairing, you don’t have to bill it separately.
Another essential point to keep in mind when filing claims for CPT code 29827 is that it includes all necessary components of arthroscopic rotator cuff repair, including diagnostic arthroscopy, limited debridement when performed as part of the repair, and anchor placement when applicable.
The code has a 90-day global period, so pre- and post-operative services should not be billed separately.
Scenarios Where CPT Code 29827 is Applicable
Below are a couple of clinical situations where CPT code 29827 can be used:
Shoulder Arthritis and Rotator Cuff Tear
Suppose a 56-year-old patient comes to an orthopedic clinic. He complains of having pain in the right shoulder. He also feels stiffness and reduced range of motion. Moreover, he has a history of repetitive overhead activities at work. Upon evaluation, the physician suspects a rotator cuff tear, which is rooted in primary osteoarthritis.
To confirm the diagnosis and treat the ailment, the physician performs a shoulder arthroscopy and rotator cuff repair surgery. In this scenario, the surgery can be billed via CPT code 29827.
Bursitis of the Left Shoulder
Let’s look at another scenario. Imagine a 45-year-old man comes to the orthopedic clinic. The patient has persistent left shoulder pain, swelling, and tenderness. He tells the physician that he frequently participates in professional sports, and the pain started during his last basketball match.
The physician suspects bursitis of the left shoulder, which has resulted in a partial tear of the rotator cuff. The physician suggests and performs an arthroscopic shoulder procedure after anesthesia administration to repair the tear. Hence, he can file a claim with code 29827 to bill the arthroscopic surgery and a relevant anesthesia code for anesthesia administration.
Applicable Modifiers for CPT Code 29827
Modifiers are an essential tool in medical billing. Without proper modifiers, your claim will be denied. The following modifiers are most frequently used with CPT code 29827:
| Modifier | Description | When To Use It |
|---|---|---|
| 52 | Reduced Services | Procedure partially reduced or eliminated at the provider’s discretion. |
| 53 | Discontinued Procedure | Procedure terminated at the provider’s discretion after anesthesia administration. |
| 59 | Distinct Procedural Service | Indicates procedure distinct from other non-E/M services on the same day. |
| 73 | Discontinued Procedure Before Anesthesia | Procedure canceled after preparation but before anesthesia due to extenuating circumstances. Used in outpatient or ASC settings. |
| 74 | Discontinued Procedure After Anesthesia | Procedure terminated after anesthesia due to extenuating circumstances. Used in outpatient or ASC settings. |
| LT | Left Side Procedures | When surgery is performed on the left shoulder. |
| RT | Right Side Procedures | When surgery is performed on the right shoulder. |
CPT Code 29827 – Billing & Reimbursement Guidelines
Attention to detail is vital when reporting CPT code 29827. Even small mistakes can lead to claim denials. To improve your claims acceptance rate, follow these guidelines.
Provide Comprehensive Documentation
Providing comprehensive documentation with your claims is vital. Without proper documentation and medical records, your insurance claims will be rejected. So, always provide details about why the arthroscopy was necessary, any imaging results that support the medical necessity, and a mention of the medications and therapy provided before opting for the surgery..
With the correct documentation, your claims are sure to achieve a better acceptance rate.
Be Wary of Global Period Rules
We have already discussed that CPT code 29827 has a global period of 90 days. If you want fair reimbursement for your claims, you must understand which services are included in the global package and which are billed separately. According to the American Academy of Orthopedic Surgeons, the following services are included and excluded from the global package:
Services included in the global package:
- Administering local anesthetics, medications, or contrast agents at any point around the procedure.
- Removing sutures or staples by the primary surgeon or their designated staff.
- Collecting samples from the wound for culturing.
- Rinsing or irrigating the wound site.
- Capturing photographs or videos during the operation (excluding those using ionizing radiation).
- Overseeing and arranging imaging or monitoring devices.
- Installing, positioning, and later removing any surgical drains, re-infusion systems, irrigation lines, or catheters.
- Closing the incision and mending any tissues.
- Applying the first dressing, brace, continuous passive motion device, splint, or cast, including any traction, unless explicitly excluded from the package.
- Preparing and placing synthetic bone replacements or agents.
- Performing a synovectomy to improve visibility during the procedure.
- Carrying out manipulation under anesthesia
Services excluded from the global package:
- Providing supplies or medications.
- Inserting, extracting, or swapping drug delivery implants.
- Arthroscopic tissue debridement.
- Arthroscopic acromioplasty procedures.
- Arthroscopic removal of the distal clavicle.
- Arthroscopic repair of a SLAP lesion.
- Arthroscopic tenodesis of the biceps tendon.
- Arthroscopic capsulorrhaphy of the shoulder.
- Arthroscopic release and removal of adhesions.
- Administering conscious sedation, regional nerve blocks, or Bier blocks.
Check the Medicare Reimbursement Amount
The national average reimbursement amount for CPT code 29827 is $1,050.29 in facility settings. However, this rate is different for each Medicare Administrative Contractor (MAC) locality. So, you can check the exact reimbursement rate for your MAC locality via the PFS Lookup Tool.
If you want to know how this global package payment will be divided into pre-operative, intra-operative, and post-operative services. Then here is a breakdown, as stated in the 2025 National Physician Fee Schedule Relative Value Unit (RVU) File:
- Pre-OP: 0.10 (10% of the total payment)
- Intra-OP: 0.69 (69% of total payment)
- Post-OP: 0.21 (21% of the total payment)
Wrapping Up
Finally, we have reached the end of our guide. CPT code 29827 represents a shoulder arthroscopy procedure to repair the rotator cuff. For proper reimbursement and to avoid denials, you must append comprehensive documentation and relevant modifiers (if necessary) with your claims.
We have covered all the relevant details, requirements, and restrictions of this CPT code to help you avoid claim denials. However, if a denial occurs, consider opting for professional orthopedic billing services for prompt resolution.
