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See a sample rate comparisonCPT 23472 Fee Schedule
Medicare rates as of October 2026
CPT 23472 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
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 | RT - Right side of body LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | $1,300.30 national non-facility rate (2026) · View Medicare rates for 23472 |
| Medicaid Fee Schedule | $1,033.92 median of the 8 states in the free preview · View Medicaid rates for 23472 |
National average reimbursement for CPT 23472 by major payers:
$2,029.46
BCBS / Anthem
$1,987.34
UnitedHealthcare
$2,092.03
Aetna
$2,380.08
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 23472.
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 table lists codes related to 23472. Select one to see its fee schedule.
| 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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Frequently Asked Questions
A CPT (Current Procedural Terminology) code is a five-digit numerical code used by medical professionals to describe medical, surgical, and diagnostic services. These codes are essential for accurate billing, claims processing, and record-keeping in the healthcare system.
To find the cost of a medical procedure tailored to your specific situation, including your location and the CPT code of the service, it's best to use specialized tools. Payerprice offers a fee schedule lookup tool that allows users to search with a CPT code and specific location to get detailed pricing information. This provides more accurate and actionable cost estimates than general information, helping you understand potential out-of-pocket expenses.
CMS (Centers for Medicare & Medicaid Services) primarily provides data on Medicare's allowable charges, which are valuable for understanding federal program rates. However, these rates often do not reflect the prices charged by commercial insurers or private providers. Payerprice, on the other hand, offers a fee schedule lookup tool that allows users to search for prices based on CPT codes and specific locations across various payers. This provides more granular and relevant pricing insights for a broader range of insurance plans and services, empowering users to compare costs and negotiate bills.
Healthcare pricing is complex due to multiple factors, including varying agreements between healthcare providers and different insurance companies, regional cost differences, the absence of comprehensive price transparency regulations in the past, and the intricate system of billing codes (like CPT codes). This complexity makes it difficult for patients to ascertain the true cost of services upfront. Tools like Payerprice aim to simplify this by providing accessible, specific fee schedule information, promoting greater transparency.