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See a sample rate comparisonCPT 23130 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.
Rotator Cuff Repair Surgery, Surgery To Repair The Rotator Cuff Of The Shoulder. The Procedure May Involve Removing A Small Amount Of Bone Or Repairing Muscles And Ligaments In The Area.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None RT - Right side of body 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 23130 |
| Medicaid Fee Schedule | View Medicaid rates for 23130 |
National average reimbursement for CPT 23130 by major payers:
$830.41
$824.65
$847.54
$1,015.85
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CPT 23130
5 of 25 sample ratesHigher to lower in this preview
Aurora Gi Asc LLC, Wisconsin Digestive Health Center
Aurora Gi Asc LLC
$10,859.00Published rateNorthbay Physician'S Surgery Center, L.L.C.
Northbay Physicians Surgery Center LLC
$3,745.00Published rateMaine Eye Center, PA
Maine Eye Center
$2,500.00Published rateHospital Drive Surgery Center, LLC
Hospital Drive Surgery Center
$1,523.50Published rateFour Corners Ambulatory Surgical Center LLC
$774.00Published rate
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See a sample payer proposalCPT 23130 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 23130 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 23130 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 |
|---|---|---|
| 23130-CPT | Moderate | Rotator Cuff Repair Surgery, Surgery To Repair The Rotator Cuff Of The Shoulder. The Procedure May Involve Removing A Small Amount Of Bone Or Repairing Muscles And Ligaments In The Area. |
| 23145-CPT | Moderate | Remove Noncancerous Growth, Surgery To Remove A Pocket Of Fluid (Cyst) Or A Noncancerous Growth (Tumor) From The Collarbone Or Shoulder Blade. The Procedure Repairs The Bone With A Graft. |
| 23146-CPT | Moderate | Remove Noncancerous Growth, Surgery To Remove A Pocket Of Fluid (Cyst) Or A Noncancerous Growth (Tumor) From The Collarbone Or Shoulder Blade. The Procedure Repairs The Bone With A Graft. |
| 23150-CPT | Moderate | Remove Noncancerous Growth, Surgery To Remove A Pocket Of Fluid (Cyst) Or A Noncancerous Growth (Tumor) From An Upper Arm Bone (Humerus). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 23130. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 23130 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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