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See a sample rate comparisonCPT 23412 Fee Schedule
Medicare rates as of October 2026
CPT 23412 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
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 | 24Ambulatory Surgical Center 22On Campus Outpatient Hospital |
| 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 | 03600975Sign up to view all 7 |
| Medicare Fee Schedule | $791.60 national non-facility rate (2026)View Medicare rates for 23412 |
| Medicaid Fee Schedule | $660.98 median of the 8 states in the free previewView Medicaid rates for 23412 |
National average reimbursement for CPT 23412 by major payers:
$1,136.47
BCBS / Anthem
$1,180.75
UnitedHealthcare
$1,227.56
Aetna
$1,420.75
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 23412.
CPT 23412
5 of 25 sample ratesHigher to lower in this preview
Campus Surgery Center LLC
Campus Surgery Center L P
$9,476.00Published rateRoseville Surgery Center, Lp, Roseville Surgery Center
Roseville Surgery Center Lp
$5,237.00Published ratePavilion Surgicenter, LLC, Physicians Pavilion Surgery Center
$2,916.00Published rateNorth Oak Ambulatory Surgery Center, LLC
$1,950.00Published rateHoliday Surgery Center Limited Partnership L L P
$520.00Published rate
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See a sample payer proposalCPT 23412 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 23412. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 23410-CPT | 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. |
| 23412-CPT | 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. |
| 23415-CPT | 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. |
| 23420-CPT | 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. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 23412. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 23412 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 23412 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 23412 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 23412 in an ambulatory surgery center?
CMS lists CPT 23412 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 23412?
Hospital price transparency files list CPT 23412 under these revenue codes: including 0360, 0975, 0960, 0989 and 0490. A revenue code names the hospital department or charge category for the line; it does not change what the service is.