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See a sample rate comparisonCPT 23405 Fee Schedule
Last Verified: September 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.
Tenomyotomy, Shoulder Area; Single
| 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 LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 23405 |
| Medicaid Fee Schedule | View Medicaid rates for 23405 |
National average reimbursement for CPT 23405 by major payers:
$842.22
$843.01
$886.14
$1,023.52
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CPT 23405
5 of 25 sample ratesHigher to lower in this preview
Wisconsin Surgery Center LLC
Wisconsin Surgery Center, LLC
$9,159.00Published rateOnyx & Pearl Surgical Suites LLC
Onyx & Pearl Surgical Suites, LLC
$3,570.00Published rateNorthfield Surgical Center LLC, Northfield Surgical Center
Northfield Surgical Center LLC
$2,795.00Published rateMain Line Surgery Center, LLC
Main Line Surgery Center
$1,666.00Published rateArizona Endoscopy Center, LLC
Arizona Endoscopy Center LLC
$956.00Published rate
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See a sample payer proposalCPT 23405 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 23405 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 23405 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 |
|---|---|---|
| 23395-CPT | High | Transfer Muscle Shoulder Single |
| 23400-CPT | High | Reposition Shoulder Blade, Surgery To Reposition The Shoulder Blade (Scapula) And Reorient The Associated Muscles And Tendons. |
| 23405-CPT | Moderate | Tenomyotomy, Shoulder Area; Single |
| 23406-CPT | High | Tenotomy Shlder Area; Multi Tendons Through Same Ncision, Tenotomy Shoulder Area; Multiple Tendons Through Same Incision |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 23405. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 23405 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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