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See a sample rate comparisonCPT 23415 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.
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 | 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service RT - Right side of body None |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 23415 |
| Medicaid Fee Schedule | View Medicaid rates for 23415 |
National average reimbursement for CPT 23415 by major payers:
$961.06
$950.00
$959.36
$1,154.39
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CPT 23415
5 of 25 sample ratesHigher to lower in this preview
Saint Lukes South Surgery Center LLC
$8,279.00Published rateEndo Surgi Center Of Old Bridge LLC
Endo-Surgi Center Of Old Bridge, LLC
$3,690.00Published rateE-Asc LLC, Beacon Evendale Surgical Center
$2,836.00Published rateWestside Surgery Center, LLC
Westside Surgery Center LLC
$1,489.00Published rateThomas Cowles
Deaconess Hospital Inc
$557.94Published rate
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See a sample payer proposalCPT 23415 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 23415 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 23415 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 |
|---|---|---|
| 23412-CPT | High | 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 | 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. |
| 23420-CPT | High | 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. |
| 23430-CPT | Moderate | Move Tendon In Upper Arm, Surgery To Cut The Normal Attachment Of The Biceps Tendon On The Shoulder Socket And Reattach It To The Arm Bone. The Procedure Treats Biceps Tendon Inflammation Or Injury. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 23415. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 23415 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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