2025 CPT code 23066
(Active) Effective Date: N/A Revision Date: N/A Surgery - Biopsy Musculoskeletal System Feed
Biopsy of deep soft tissue in the shoulder area.
Modifiers may be applicable depending on the circumstances of the procedure.For example, modifier 51 may be used for multiple procedures, modifier 76 if a repeat procedure was performed by the same physician, and modifier 59 if the procedure was distinct or separate from other procedures.
The medical necessity for a deep soft tissue biopsy (23066) is established when a palpable mass, imaging abnormality, or other clinical findings raise suspicion of a pathologic condition requiring histopathological examination. The decision to perform the procedure is based on the physician's clinical judgment after a thorough evaluation of the patient's history, physical examination, and imaging studies, if any.
The physician or qualified healthcare professional is responsible for prepping the patient, administering anesthesia (if necessary), making the incision, excising the tissue sample using microdissection, sending the specimen to the lab, irrigating the wound, and closing the incision with sutures.
- Musculoskeletal System
- Musculoskeletal System > Surgical Procedures on the Musculoskeletal System > Biopsy
In simple words: The doctor takes a small sample of tissue from deep inside the shoulder area to check for cancer or other problems under a microscope.This involves a small cut, removal of a sample of tissue, cleaning the area, and stitching up the cut.
This CPT code encompasses the excisional biopsy of deep soft tissue within the shoulder region.The procedure involves an incision over the suspicious area, extending through the fascia and/or muscle, using microdissection to excise a tissue sample for pathological analysis.The wound is then irrigated and closed with sutures.Appreciable vessel exploration or neuroplasty, if performed, are reported separately.
Example 1: A 55-year-old male presents with a palpable mass in his right shoulder.The physician performs an excisional biopsy (23066) to determine the nature of the mass, which is suspected to be a soft tissue sarcoma., A 30-year-old female reports chronic pain and tenderness in her left shoulder. Imaging reveals an unusual soft tissue lesion.An excisional biopsy (23066) is performed to rule out malignancy., A 70-year-old patient with a history of rheumatoid arthritis presents with a deep tissue lesion in the left shoulder, causing limited range of motion. To investigate the cause, an excisional biopsy (23066) is done.
* Preoperative diagnosis and clinical indications for the biopsy.* Detailed description of the procedure, including incision location, depth, and technique (microdissection).* Size and location of the excised tissue.* Pathological report confirming the diagnosis.* Operative report including details of the procedure and any complications encountered.* Anesthesia record if applicable.
** Always confirm payer-specific coding and billing rules for this procedure.Consider state and local regulations.Ensure compliance with all applicable guidelines to avoid payment denials or other issues.
- Revenue Code: P5B (AMBULATORY PROCEDURES - MUSCULOSKELETAL)
- RVU: Information not available in provided text. Refer to the current CPT codebook or other relevant fee schedule for RVU data.
- Global Days: Information not available in provided text. Consult current CPT guidelines for global period details.
- Payment Status: Active
- Modifier TC rule: The information about TC modifier applicability is not available in the provided text. Refer to the current CPT manual or other appropriate resources.
- Fee Schedule: The information is unavailable in the provided text.Check historical CPT data or other fee schedule resources.
- Specialties:Orthopedic Surgery, General Surgery, Oncology
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)