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See a sample rate comparisonCPT 23040 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Arthrotomy Glenohumeral Joint, Arthrotomy Glenohumeral Joint Including Explorationdrainage Or Removal Of Foreign Body Arthrotomy Glenohumeral Joint Including Exploration
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 23040 |
| Medicaid Fee Schedule | View Medicaid rates for 23040 |
National average reimbursement for CPT 23040 by major payers:
$968.27
$970.65
$1,006.19
$1,182.90
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CPT 23040
5 of 25 sample ratesHigher to lower in this preview
Fish Pond Surgery Center, LLC
Fish Pond Surgery Center LLC
$4,339.00Published rateMedplex Outpatient Surgery Center Ltd, Medplex Outpatient Surgery Center
Medplex Outpatient Surgery Center Ltd
$3,347.00Published rateRegional Eye Surgery Center, LLC
$2,090.00Published rateNcbh Outpatient Endoscopy Center, L.L.C., Wake Forest Baptist Health Outpatient Endoscopy - Quaker Lane
Ncbh Outpatient Endoscopy Center LLC
$1,237.00Published rateMethodist Mansfield Ambulatory Surgery Center, LLC
Methodist Mansfield Ambulatory Surgery Center Ll
$496.00Published rate
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See a sample payer proposalCPT 23040 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 23040 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 23040 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 23030-CPT | Moderate | Drain Shoulder Infection, Surgery To Cut Open And Drain A Deep Infection Or Collection Of Blood (Hematoma) From The Shoulder. |
| 23031-CPT | Moderate | Drain Shoulder Infection, Surgery To Cut Open And Drain A Deep Infection Or Collection Of Blood (Hematoma) From The Shoulder. |
| 23035-CPT | Moderate | Ncision Bone Cortex (Eg Osteomyeli Or Bone Absces) Shlder, Incision Bone Cortex (Eg Osteomyelitis Or Bone Abscess) Shoulder Ar |
| 23040-CPT | Moderate | Arthrotomy Glenohumeral Joint, Arthrotomy Glenohumeral Joint Including Explorationdrainage Or Removal Of Foreign Body Arthrotomy Glenohumeral Joint Including Exploration |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 23040. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 23040 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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