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See a sample rate comparisonCPT 23100 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.
Shoulder Surgery With Biopsy, Exploratory Surgery Of A Shoulder Joint. The Procedure Includes Removal Of A Sample Of Tissue For Testing (Biopsy).
| 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 23100 |
| Medicaid Fee Schedule | View Medicaid rates for 23100 |
National average reimbursement for CPT 23100 by major payers:
$714.95
$674.17
$693.06
$834.44
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CPT 23100
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Surgery Center Kingsland LLC, Memorial Hermann Surgery Center Kingsland
$5,048.00Published rateSurgery Centre Of Sw Florida LLC, Cape Health Surgery Center
$2,206.00Published rateLewis & Clark Orthopaedic Institute LLC
Lewis & Clark Orthopaedic, LLC 401(K) Plan
$1,348.00Published rateNovamed Surgery Center Of Orlando LLC, Downtown Surgery Center
Novamed Surgery Center Of Orlando LLC
$889.00Published rateSummer El-Khodary
Deaconess Hospital Inc
$400.77Published rate
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See a sample payer proposalCPT 23100 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 23100 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 23100 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 |
|---|---|---|
| 23040-CPT | Moderate | Arthrotomy Glenohumeral Joint, Arthrotomy Glenohumeral Joint Including Explorationdrainage Or Removal Of Foreign Body Arthrotomy Glenohumeral Joint Including Exploration |
| 23100-CPT | Moderate | Shoulder Surgery With Biopsy, Exploratory Surgery Of A Shoulder Joint. The Procedure Includes Removal Of A Sample Of Tissue For Testing (Biopsy). |
| 23101-CPT | Moderate | Collarbone Surgery, Surgery On The Joint Between Collarbone And Shoulder Blade. The Procedure May Include Draining An Infection Removing A Foreign Object Or Taking A Sample Of Tissue For Testing (Biopsy). |
| 23106-CPT | Moderate | Collarbone Joint Surgery, Surgery To Remove Tissue From Inside The Joint Between The Collarbone And Breastbone. The Procedure May Include Removing A Sample Of Tissue For Testing (Biopsy). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 23100. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 23100 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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