Wiki CPT 29826 denials

[kkindle1807]

I'm inquiring to see if anyone else is having an issue with CPT 29826 not getting paid even though the operative report is stating both subacromial decompression and acromioplasty in a separate paragraph.
We are noticing an increase in denials when 29826 is billed along with 29827, 29828, 29823 (the extensive debridement will be outlined in a separate paragraph from the subacromial decompression and acromioplasty).
It's not just these 4 procedures billed out that are denying the 29826, it can be any combination, 29827, 29823, 29824, 29826 - they are still denying the 29826.

Forgot to add, we always include a 59 modifier on the 29826.

Has anyone else noticed this and if so have you come up with any solutions that don't require a write off?

 

[NRaizman]

The reason 29826 is being denied is for lack of medical necessity. It has nothing to do with the coding.

Subacromial decompression has not been shown, either alone or when it is done in conjunction with cuff repair, to have any benefit. This is part of the AAOS Clinical Practice Guidelines for Rotator Cuff. Makes it hard to justify.

It will still generally get paid by CMS, but third party payors are mostly denying it across the board. It is unlikely to be worth appealing, and I would recommend only using the bursa and acromion as structures for debridement to count towards 29823.
N

 

[candacerein@gmail.com]

I have had most of my billed surgerys with CPT 29827, 29826, 29828 and 29823 with the 29823 denied due to bundled with 29827. When speaking to BCBS they stated this is bundled. Anyone have advice on what I can do differently ?

 

[amyjph]

I have had most of my billed surgerys with CPT 29827, 29826, 29828 and 29823 with the 29823 denied due to bundled with 29827. When speaking to BCBS they stated this is bundled. Anyone have advice on what I can do differently ?

Just an example below; have you read the policies of the health plan being billed, read/recently or researched a bit?
Example: https://www.blueshieldca.com/conten...ions/PRV_Partial_Thick_Rotator_Cuff_Tears.pdf
If the health plan follows NCCI search 29823 here: https://www.cms.gov/files/document/04-chapter4-ncci-medicare-policy-manual-2026-final.pdf
In your example you have three other procedures being reported in the same anatomic area/shoulder scopes. It's doubtful there were 3 or more discrete structures (separate from) the other CPTs to support 29823.

This is old from when the CPT 29822 & 29823 changes happened but has good info: https://www.kzanow.com/articles/arthroscopy-coding-for-major-joints-shoulder
From 2025 & talks about UHC: https://www.kzanow.com/alerts/united-healthcare-policy-updates-2-1-25
This is an older example from Kaiser but helps show what some plans do: https://wa-provider.kaiserpermanente.org/static/pdf/provider/billing-claims/shoulder-arthroscopy.pdf

Also read the forum threads here for other discussion about these codes: https://www.aapc.com/discuss/thread...-29826-or-29823.208756/?view=date#post-566739

D

Wiki Thread 'Shoulder Question'

Aug 8, 2025

Good morning! I need some help coding this op note, please! I see the 29828, and there is enough to bill 29823. What I am not sure about is 29826. I would greatly appreciate any help!

The patient was seen preoperatively, site was marked and
verified. Preoperative antibiotics were given. She was taken back to the OR. She was placed in a beach
chair position. All bony prominences were well padded. A posterior portal was established. We used an
inside-out technique to create an anterior portal. We then began to evaluate the joint. The cartilage
surfaces on the humeral head and glenoid were...

• dsibley67
• Replies: 3
• Forum: Orthopaedics