Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 23455 Fee Schedule
CPT 23455 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Repair Shoulder Capsule, Reattachment Of Shoulder Joint Capsule And Cartilage Without Bone Transfer With Repair Of Shoulder Rim
| 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) | J8 - Device-intensive procedure, paid at an adjusted rate |
| Common Revenue Codes | 03600960 |
| Medicare Fee Schedule | View Medicare rates for 23455 |
| Medicaid Fee Schedule | $702.695 median of the 8 states in the free previewView Medicaid rates for 23455 |
National average reimbursement for CPT 23455 by major payers:
$1,322.48
BCBS / Anthem
$1,359.11
UnitedHealthcare
$1,391.24
Aetna
$1,635.43
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 23455.
CPT 23455
5 of 25 sample ratesHigher to lower in this preview
Central Louisiana Ambulatory Surgical Center LLC
Central Louisiana Surgical Hospital, LLC
$8,662.00Published rateUniversity Center For Ambulatory Surgery, LLC
University Center For Ambulatory Surgery LLC
$4,966.00Published ratePhoenix Spine And Joint Gilbert Asc, LLC
$4,033.00Published rateAtlanta Surgery Centers, Atlanta Surgery Centers
$2,824.00Published rateMsc Ambulatory Surgical Center
$1,587.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Looking for other data?
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 23455 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 23455. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 23450-CPT | Capsulorrhaphy Anterio; Putti-Platt Proc Or Magnuson Typ Opera, Capsulorrhaphy Anterior; Putti-Platt Procedure Or Magnuson Type Opera |
| 23455-CPT | Repair Shoulder Capsule, Reattachment Of Shoulder Joint Capsule And Cartilage Without Bone Transfer With Repair Of Shoulder Rim |
| 23460-CPT | Capsul-Recur.Disloc,Any;Bone Block |
| 23462-CPT | Capsulorrhaphy Anterio Any Typ; W/ Coracoid Process Trnsfer, Capsulorrhaphy Anterior Any Type; With Coracoid Process Transfer |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 23455. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 23455 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 23455) and we'll show you how you compare in 15 minutes or less.
Frequently Asked Questions
What APC is CPT 23455 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 23455 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 23455 in an ambulatory surgery center?
CMS lists CPT 23455 with ASC payment indicator J8: Device-intensive procedure, paid at an adjusted rate.
Which revenue codes are billed with CPT 23455?
Hospital price transparency files list CPT 23455 under these revenue codes: 0360 and 0960. A revenue code names the hospital department or charge category for the line; it does not change what the service is.