CPT 23470 Fee Schedule
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.
| 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 |
National average reimbursement for CPT 23470 by major payers:
$1,696.71
$1,634.96
$1,704.09
$2,016.38
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 23470 | ||||||
United | 23470 | $8917.00 | 1649223124 - CAMP LOWELL SURGERY CENTER,LLC, CAMP LOWELL SURGERY CENTER | 201086556 - (AZ) CAMP LOWELL SURGERY CENTER | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $3907.00 | 1265438303 - EYE SURGERY CENTER OF CHATTANOOGA, LLC | 200149350 - (TN) EYE SURGERY CENTER OF CHATTANOOGA LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $8000.00 | 1982880274 - BURLINGTON COUNTY ENDOSCOPY CENTER LLC | 208205206 - (NJ) BURLINGTON COUNTY ENDOSCOPY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $4000.00 | 1225188808 - LOS ANGELES ENDOSCOPY CENTER, LOS ANGELES AMBULATORY SURGERY CENTER | 954775738 - (CA) LOS ANGELES ENDOSCOPY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $1185.00 | 1770557233 - MESA AZ ENDOSCOPY ASC LLC, DESERT ENDOSCOPY CENTER | 510426858 - (AZ) THE MESA AZ ENDOSCOPY ASC, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $18467.00 | 1760931349 - SF NASSAU ASC LLC | 300870382 - (NY) SF NASSAU ASC LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $9324.00 | 1063092047 - TAMPA BAY JOINT AND SPINE, LLC, TAMPA BAY JOINT AND SPINE SURGERY CENTER | 851259146 - (FL) TAMPA BAY JOINT AND SPINE LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $9510.00 | 1962714154 - SURGCENTER OF WHITE MARSH, LLC | 272873637 - (MD) SURGCENTER OF WHITE MARSH, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $2445.00 | 1891857850 - CARES AMBULATORY SURGERY SERVICES | 223557777 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $1575.00 | 1689860124 - PINE GROVE AMBULATORY SURGICAL | 203237578 - (PA) PINE GROVE AMBULATORY SURGICAL | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $1250.00 | 1265542849 - GREAT LAKES EYE SURGERY CENTER LLC | 205428461 | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $1100.00 | 1902834922 - SOUTHWESTERN EYE CENTER LTD, SOUTHWESTERN EYE CENTER | 860423068 - SOUTHWESTERN EYE CENTER, LTD. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $4862.00 | 1669540118 - STEVENS KIM MD AND STEPHEN LIN MD MEDICAL GROUP INC, VALLEY LASER SURGERY CENTER, INC. | 203111961 - (CA) STEVENS KIM MD AND STEPHEN LIN MD MEDICAL GROUP INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $2623.00 | 1346322187 - XRS LLC, COLUMBUS PAIN INSTITUTE | 201384877 - (IN) XRS LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $4157.00 | 1720262405 - BATON ROUGE LA ENDOSCOPY ASC LLC, LOUISIANA ENDOSCOPY CENTER | 261168310 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 23470 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 23470 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 23470 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 |
|---|---|---|
| 23335-CPT | High | Removal Of Prosthesis, Includes Debridement And Synovectomy When Performed; Humeral And Glenoid Components (Eg, Total Shoulder) |
| 23430-CPT | Moderate | Tenodesis-Rupt-Long Tendon-Biceps |
| 23470-CPT | High | Arthroplas,Prox.Humeral Implnt-Neer |
| 23472-CPT | High | Surgical Service Bundle Includes All Surgery Related Health Services Which Are Incurred In Connection With An Approved Outpatient Surgical Procedure, Billed Via The Agreed Upon Cpt Codes And Reimbursed At A Single Payment Rate Including All Services Such |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 23470. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 23470 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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