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See a sample rate comparisonCPT 23420 Fee Schedule
Medicare rates as of October 2026
CPT 23420 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 | 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) | J8 - Device-intensive procedure, paid at an adjusted rate |
| Common Revenue Codes | 03600975Sign up to view all 5 |
| Medicare Fee Schedule | $906.50 national non-facility rate (2026)View Medicare rates for 23420 |
| Medicaid Fee Schedule | $748.965 median of the 8 states in the free previewView Medicaid rates for 23420 |
National average reimbursement for CPT 23420 by major payers:
$1,310.22
BCBS / Anthem
$1,328.82
UnitedHealthcare
$1,364.90
Aetna
$1,607.88
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 23420.
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 table lists codes related to 23420. 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 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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Frequently Asked Questions
What APC is CPT 23420 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 23420 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 23420 in an ambulatory surgery center?
CMS lists CPT 23420 with ASC payment indicator J8: Device-intensive procedure, paid at an adjusted rate.
Which revenue codes are billed with CPT 23420?
Hospital price transparency files list CPT 23420 under these revenue codes: 0360, 0975, 0960, 0490 and 0361. A revenue code names the hospital department or charge category for the line; it does not change what the service is.