Arthroscopy, shoulder, surgical; capsulorrhaphy

CPT 29806 is the billing code for "Arthroscopy, shoulder, surgical; capsulorrhaphy". For surgical shoulder arthroscopy with capsulorrhaphy

Medicare pays approximately $1042.20 for CPT 29806 (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 29806 has a total RVU of 31.05, broken down as: Work RVU 13.50, Practice Expense RVU 16.20, and Malpractice RVU 1.35. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 29806 include: Indication for capsulorrhaphy; Extent of capsular repair; Type of instability; Repair technique. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 29806: Includes surgical arthroscopy. Includes capsulorrhaphy Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 29806 include: 50 (Bilateral procedure when both shoulders performed same session), 51 (Multiple procedures performed same session), 22 (Increased procedural services for complex repair). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 29806 is 60-90 minutes typical operative time. Time-based codes require documentation of the actual time spent providing the service.