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See a sample rate comparisonCPT 23415 Fee Schedule
Medicare rates as of October 2026
CPT 23415 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 | 59Distinct Procedural Service RTRight 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 | 0360 |
| Medicare Fee Schedule | $658.33 national non-facility rate (2026)View Medicare rates for 23415 |
| Medicaid Fee Schedule | $526.075 median of the 8 states in the free previewView Medicaid rates for 23415 |
National average reimbursement for CPT 23415 by major payers:
$961.06
BCBS / Anthem
$950.00
UnitedHealthcare
$959.36
Aetna
$1,154.39
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 23415.
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 table lists codes related to 23415. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 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. |
| 23430-CPT | 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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Frequently Asked Questions
What APC is CPT 23415 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 23415 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 23415 in an ambulatory surgery center?
CMS lists CPT 23415 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 23415?
Hospital price transparency files list CPT 23415 under these revenue codes: 0360. A revenue code names the hospital department or charge category for the line; it does not change what the service is.