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See a sample rate comparisonCPT 23405 Fee Schedule
Medicare rates as of October 2026
CPT 23405 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Tenomyotomy, Shoulder Area; Single
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 22On Campus Outpatient Hospital 24Ambulatory Surgical Center |
| Common Modifiers | RTRight side of body LTLeft side of body |
| Hospital Outpatient Group (APC) | APC 5114 - Level 4 Musculoskeletal Procedures |
| Surgery Center Payment (ASC) | A2 - Paid separately, from the OPPS relative weight |
| Common Revenue Codes | 03600761Sign up to view all 6 |
| Medicare Fee Schedule | $574.50 national non-facility rate (2026)View Medicare rates for 23405 |
| Medicaid Fee Schedule | $460.275 median of the 8 states in the free previewView Medicaid rates for 23405 |
National average reimbursement for CPT 23405 by major payers:
$842.22
BCBS / Anthem
$843.01
UnitedHealthcare
$886.14
Aetna
$1,023.52
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 23405.
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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Payer Contract Negotiation
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See a sample payer proposalCPT 23405 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 23405. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 23395-CPT | Transfer Muscle Shoulder Single |
| 23400-CPT | Reposition Shoulder Blade, Surgery To Reposition The Shoulder Blade (Scapula) And Reorient The Associated Muscles And Tendons. |
| 23405-CPT | Tenomyotomy, Shoulder Area; Single |
| 23406-CPT | 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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Frequently Asked Questions
What APC is CPT 23405 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 23405 to APC 5114 (Level 4 Musculoskeletal Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 23405 in an ambulatory surgery center?
CMS lists CPT 23405 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 23405?
Hospital price transparency files list CPT 23405 under these revenue codes: including 0360, 0761, 0361, 0960 and 0975. A revenue code names the hospital department or charge category for the line; it does not change what the service is.