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See a sample rate comparisonCPT 23420 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 23420 |
| Medicaid Fee Schedule | View Medicaid rates for 23420 |
National average reimbursement for CPT 23420 by major payers:
$1,310.22
$1,328.82
$1,364.90
$1,607.88
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CPT 23420
5 of 25 sample ratesHigher to lower in this preview
Iu Health Arnett Hospital, Inc, Arnett Surgery Center, LLC
Indiana University Health Arnett Inc
$13,049.00Published rateCenter For Orthopedic Surgery, LLC
Center For Orthopedic Surgery LLC
$3,819.00Published rateNorth Point Surgery Center, Inc
North Point Surgery Center
$2,650.00Published rateJudith Canlas
Deaconess Hospital Inc
$1,690.31Published rateMid-Bronx Endoscopy Center LLC
Midbronx Endoscopy Center LLC
$530.00Published rate
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See a sample payer proposalCPT 23420 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 23420 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 23420 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 |
|---|---|---|
| 23410-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. |
| 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. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 23420. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 23420 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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