Orthopedic Billing Guidance - CPT Code 29826

Orthopedic physicians and support staff likely know that CPT code 29826 (arthroscopy, shoulder surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament release, when performed) became an add-on code on January 1, 2012. As Precision works with Orthopedic practices, we have discovered there are still misunderstandings regarding when this CPT code should be billed and therefore want to clarify the proper use of this code.

CPT 29826 can only be billed along with one (or more) of the following CPT codes:
29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29827 and 29828.

By way of example, if a provider performs an arthroscopic subacromial decompression or acromioplasty but does not perform any other procedure in the same operative setting, the provider should bill CPT code 29822 or 29823, depending upon the extent of the work involved. However, if the provider performs the decompression or acromioplasty together with an arthroscopic rotator cuff repair, the provider would bill CPT code 29827 and add on the CPT 29826.

Please note the foregoing information follows Medicare Guidelines but it is possible certain commercial payers may not accept or adhere to the same guidelines. Please don’t hesitate to contact Precision if you have any questions regarding this add-on code or its treatment by Medicare or any of the commercial payers.