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See a sample rate comparisonCPT 23474 Fee Schedule
Last Verified: October 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.
Fix Shoulder Replacement, Surgery To Fix An Artificial Shoulder Replacement That Was Done Sometime In The Past. The Procedure May Include Transplanting Tissue.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 23474 |
| Medicaid Fee Schedule | View Medicaid rates for 23474 |
National average reimbursement for CPT 23474 by major payers:
$2,399.97
$2,458.31
$2,447.28
$2,862.31
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CPT 23474
5 of 25 sample ratesHigher to lower in this preview
Orlando Surgicare Ltd
$26,475.00Published rateSkyway Surgery Center, LLC
Skyway Surgery Center LLC
$6,365.00Published rateHealthcare Partners Asc-Hb, LLC, Talbert Surgical Associates, LLC
Healthcare Partners Aschb LLC
$3,937.00Published rateMid-Atlantic Endoscopy Center, LLC, Mid-Atlantic Gastrointestinal Center II
Midatlantic Endoscopy Center LLC
$2,855.00Published rateBoise Endoscopy Center, LLC, Canyon County Endoscopy Center
Boise Endoscopy Center LLC
$1,222.00Published rate
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See a sample payer proposalCPT 23474 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 23474 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 23474 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 23474. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 23474 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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