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 |
| Medicare Fee Schedule | View Medicare rates for 23470 |
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 | $2400.00 | 1659377042 - TOMS RIVER AMBULATORY SURGICAL CENTER, BEY LEA AMBULATORY SURGICAL CENTER | 223802381 - (NJ) TOMS RIVER AMBULATORY SURGICAL CENTER | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $1572.00 | 1932136389 - SURGERY CENTER AT 900 N MICHIGAN AVE LLC | 364234488 - (IL) SURGERY CENTER AT 900 N MICHIGAN AVE LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $5038.00 | 1972675668 - TEXAS REGIONAL EYE CENTER ASC LLC, TEXAS REGIONAL EYE CENTER ASC LLC | 710967940 - (TX) TEXAS REGIONAL EYE CENTER ASC LLC | TX | 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 | $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 | $1189.00 | 1811914625 - PUGET SOUND GASTROENTEROLOGY, PLLC, EDMONDS ENDOSCOPY CENTER | 911123468 - (WA) PUGET SOUND GASTROENTEROLOGY, P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $5657.00 | 1689311938 - HURON GASTRO ENDOSCOPY CENTER LLC, HURON GASTRO CENTER FOR DIGESTIVE CARE | 853580801 - (MI) HURON GASTRO ENDOSCOPY CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $3671.00 | 1952602609 - GASTROENTEROLOGY & HEPATOLOGY CONSULTANTS, PA, WAKE FOREST ENDOSCOPY CENTER | 562189630 - (NC) GASTROENTEROLOGY AND HEPATOLOGY CONSULTANTS, P.A. | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $19773.00 | 1245605633 - HARBOR HEIGHTS SURGERY CENTER, LLC | 473886948 - (MD) HARBOR HEIGHTS SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $8917.00 | 1649515354 - SURGCENTER NORTHEAST LLC | 455554995 - (FL) SURGCENTER NORTHEAST, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $7006.00 | 1619037066 - THE EL DORADO AR MULTISPECIALTY ASC LLC, SOUTH ARKANSAS SURGERY CENTER | 203954951 - (AR) THE EL DORADO AR MULTISPECIALTY ASC LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $3030.00 | 1720161771 - EYE CARE SURGERY CENTER OF OLIVE BRANCH,LLC | 470920340 | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $3093.00 | 1760875983 - BAPTIST MEDICAL PARK SURGERY CENTER, LLC | 593535262 - (FL) BAPTIST MEDICAL PARK SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $9324.00 | 1962788059 - SURGCENTER OF SILVER SPRING, LLC | 452950933 - (MD) SURGCENTER OF SILVER SPRING LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23470 | $4598.00 | 1497843825 - COMMONWEALTH ORTHOPAEDICS & REHABILITATION, PC | 540885859 - (VA) ORTHOVIRGINIA, INC. | VA | 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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