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See a sample rate comparisonCPT 23472 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.
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
| 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 23472 |
| Medicaid Fee Schedule | View Medicaid rates for 23472 |
National average reimbursement for CPT 23472 by major payers:
$2,029.46
$1,987.34
$2,092.03
$2,380.08
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CPT 23472
5 of 25 sample ratesHigher to lower in this preview
Nicholas Moylan
Summit Medical Group, P.A.
$5,168.58Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$3,625.89Published rateEric Wininger
Atlantic Health System Inc
$3,097.80Published rateDevin Eckstein
Advocare, LLC
$2,622.11Published rateEstela Wajcberg
Saint Peters University Hospital
$2,036.72Published rate
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See a sample payer proposalCPT 23472 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 23472 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 23472 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 |
|---|---|---|
| 23470-CPT | High | Arthroplasty Glenohumeral Joi, Arthroplasty Glenohumeral Joint Hemiarthroplastyarthroplasty Glenohumeral Joint Hemiarthroplasty |
| 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 |
| 23473-CPT | High | Fix Shoulder Replacement, Surgery To Fix An Artificial Shoulder Replacement That Was Done Sometime In The Past. The Procedure May Include Transplanting Tissue. |
| 23474-CPT | High | Fix Shoulder Replacement, Surgery To Fix An Artificial Shoulder Replacement That Was Done Sometime In The Past. The Procedure May Include Transplanting Tissue. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 23472. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 23472 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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