CPT 23490 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 | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • RT - Right side of body • 51 - Multiple procedures |
| Complexity Level | High |
National average reimbursement for CPT 23490 by major payers:
$1,130.48
$1,155.86
$1,171.47
$1,439.93
| 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 23490 | ||||||
United | 23490 | $6183.00 | 1821510579 - NOVANT HEALTH BRUNSWICK ENDOSCOPY CENTER, LLC, NOVANT HEALTH BRUNSWICK ENDOSCOPY | 820831203 - (NC) NOVANT HEALTH BRUNSWICK ENDOSCOPY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23490 | $900.00 | 1386632610 - LHZ LIMITED PTR, SAINT CLARE SURGERY CENTER | 341816442 - (OH) LHZ LIMITED PTR | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23490 | $6492.00 | 1154474583 - CREEKWOOD SURGERY CENTER, LP | 431656044 - (MO) CREEKWOOD SURGERY CENTER LP | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23490 | $2665.00 | 1285889378 - PARADIGM CLINICAL ASSOCIATES LLC, STRATHAM AMBULATORY SURGERY CENTER | 262382365 - (NH) PARADIGM CLINICAL ASSOCIATES, LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23490 | $6087.00 | 1427152073 - PATIENT PARTNERS LLC | 201400198 - (TN) PATIENT PARTNERS LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23490 | $3012.00 | 1194275230 - WEST SUBURBAN EYE SURGERY CENTER LLC, SURGISITE NORTH | 201671234 - (MA) WEST SUBURBAN EYE SURGERY CENTER, LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23490 | $6365.00 | 1700502150 - MOUNT PLEASANT OUTPATIENT SURGERY CENTER LLC | 883714959 - (SC) MOUNT PLEASANT OUTPATIENT SURGERY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23490 | $5655.00 | 1750505756 - SJ MEDICAL CENTER, LLC | 204835578 - (TX) SJ MEDICAL CENTER, LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23490 | $3515.00 | 1912267592 - SURGCENTER AT NATIONAL HARBOR, LLC, HARBORSIDE SURGERY CENTER | 454110190 - (MD) HARBORSIDE SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23490 | $3000.00 | 1003004482 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23490 | $4702.00 | 1467490433 - UROLOGY SURGICAL CENTER LLC | 470814279 - (NE) UROLOGY SURGICAL CENTER | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23490 | $1390.00 | 1922104710 - OAKS SURGERY CENTER LP | 753019861 - (CA) OAKS SURGERY CENTER LP THE OAK | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23490 | $2961.00 | 1154526044 - KERRVILLE AMBULATORY SURGERY CENTER, LLC | 205121858 - (TX) KERRVILLE AMBULATORY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23490 | $1861.00 | 1154555472 - GEORGIA RETINA SURGERY CENTER, LLC | 262303683 - (GA) GEORGIA RETINA SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23490 | $3275.00 | 1235789041 - MAPLESHADE SURGERY CENTER, LLC | 814826814 - (TX) MAPLESHADE SURGERY CENTER LLC | TX | 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 23490 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 23490 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 23490 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 |
|---|---|---|
| 23480-CPT | High | Osteotomy,Clavic,W/Wo Internal Fix; |
| 23485-CPT | High | Osteotomy, Clavicle, With Or Without Internal Fixation; With Bone Graft For Nonunion Or Malunion (Includes Obtaining Graft And/Or Necessary Fixation) |
| 23490-CPT | High | Prophy Tx W/Wo M.Methacrylate;Clav |
| 23491-CPT | High | Prophylactic Treatment Prox Humerus |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 23490. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 23490 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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