Arthroscopy, shoulder, diagnostic; with or without synovial biopsy

CPT 29805 is the billing code for "Arthroscopy, shoulder, diagnostic; with or without synovial biopsy". For diagnostic shoulder arthroscopy with or without synovial biopsy

Medicare pays approximately $468.70 for CPT 29805 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.

CPT 29805 has a total RVU of 18.60, broken down as: Work RVU 8.00, Practice Expense RVU 9.80, and Malpractice RVU 0.80. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 29805 include: Indication for diagnostic arthroscopy; Findings in each compartment; Synovial biopsy if performed; Any pathology identified. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 29805: Includes diagnostic arthroscopy. Includes synovial biopsy if performed Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 29805 include: 50 (Bilateral procedure when both shoulders performed same session), 51 (Multiple procedures performed same session), LT (Left side procedure). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 29805 is 30-45 minutes typical operative time. Time-based codes require documentation of the actual time spent providing the service.