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See a sample rate comparisonCPT 23195 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Resection Humeral Head
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 23195 |
| Medicaid Fee Schedule | View Medicaid rates for 23195 |
National average reimbursement for CPT 23195 by major payers:
$1,042.43
$1,011.42
$1,017.30
$1,229.94
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CPT 23195
5 of 25 sample ratesHigher to lower in this preview
Columbia North Hills Hospital Subsidiary Lp, Medical City North Hills
Columbia North Hills Hospital Subsidiary Lp
$9,916.00Published rateSurgery Center Of Scottsdale, LLC, Mountain View Surgery Center Of Phoenix
Surgery Center Of Scottsdale LLC
$2,755.00Published ratePhysicians Alliance Lc, Physicians Alliance Surgery Center
Physicians Alliance Lc
$2,128.00Published rateBakersfield Specialty Surgery Center, PC
Bakersfield Specialty Surgery Center PC
$1,632.00Published rateNovamed Surgery Center Of Columbus, LLC
Novamed Surgery Center Of Columbus LLC
$661.00Published rate
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See a sample payer proposalCPT 23195 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 23195 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 23195 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 |
|---|---|---|
| 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). |
| 23156-CPT | Moderate | Remove Noncancerous Growth, Surgery To Remove A Pocket Of Fluid (Cyst) Or A Noncancerous Growth (Tumor) From An Upper Arm Bone (Humerus). The Procedure Uses A Bone Graft To Repair The Area. |
| 23190-CPT | Moderate | Ostectomy Scapula Partial |
| 23195-CPT | High | Resection Humeral Head |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 23195. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 23195 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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