CPT 23616 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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 23616 |
National average reimbursement for CPT 23616 by major payers:
$1,741.72
$1,721.87
$1,749.94
$2,121.32
| 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 23616 | ||||||
United | 23616 | $3500.00 | 1003116823 - NORTHERN N.J. ENDOSCOPY CENTER, L.L.C. | 640955113 - (NJ) NORTHERN NJ ENDOSCOPY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23616 | $4918.00 | 1386190957 - HOLLY SPRINGS SURGERY CENTER, LLC | 473460976 - (NC) HOLLY SPRINGS SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23616 | $3500.00 | 1780789024 - LINDEN SURGICAL CENTER, LLC | 223634504 - (NJ) LINDEN SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23616 | $1169.00 | 1386793370 - SURGERY CENTER OF WEST MONROE, LLC | 721509507 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23616 | $6087.00 | 1538461348 - THE OUTPATIENT CENTER, LLC, THE OUTPATIENT CENTER OF BOYNTON BEACH, LTD. D/B/A THE OUTPATIENT CENT | 650440864 - (FL) THE OUTPATIENT CENTER OF BOYNTON BEACH, LTD. | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23616 | $6492.00 | 1558487009 - MIDWEST DIGESTIVE HEALTH CENTER LLC | 431918703 - (MO) MIDWEST DIGESTIVE HEALTH CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23616 | $3550.00 | 1821101197 - OLYMPIA MULTI-SPECIALTY CLINIC AMBULATORY PROCEDURES CNTR PLLC | 911703278 - (WA) OLYMPIA MULTISPECIALTY CLINIC AMBULATORY PROCEDURES CNTR PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23616 | $11106.00 | 1629249172 - NORTH STATE SURGERY CENTERS LP, COURT STREET SURGERY CENTER | 300197423 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23616 | $3350.00 | 1245331628 - BERNSTEIN HILLIKER HARTZELL EYE CENTER LLP, THE SURGERY CENTER OF CENTRAL PA | 232196399 - (PA) THE EYE CENTER OF CENTRAL PA, LLP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23616 | $4189.00 | 1720752629 - BAY SURGERY CENTERS | 453365193 - (MD) BAY SURGERY CENTERS | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23616 | $4656.00 | 1215531215 - HAUPPAUGE SC, LLC | 352651325 - (NY) HAUPPAUGE SC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23616 | $3239.00 | 1770004772 - NORTHWEST ATLANTA VASCULAR CARE LLC | 453857694 - (GA) NORTHWEST ATLANTA VASCULAR CARE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23616 | $4700.00 | 1073113841 - SPINE SOLUTIONS OF WEST BEND LLC | 853661644 - (WI) SPINE SOLUTIONS OF WEST BEND LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23616 | $6556.00 | 1134182660 - CORAL SPRINGS SURGI-CENTER LTD | 650538147 - (FL) CORAL SPRINGS SURGICENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23616 | $822.00 | 1538113238 - ADVANCED LASER & SURGICENTER OF ARIZONA, PC | 721546625 | AZ | 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 23616 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 23616 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 23616 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 |
|---|---|---|
| 23600-CPT | Moderate | Close Prox Humeral Fract Wo Manip |
| 23605-CPT | Moderate | Closed Treatment Of Proximal Humeral (Surgical Or Anatomical Neck) Fracture; With Manipulation, With Or Without Skeletal Traction |
| 23615-CPT | High | Open Treatment Of Proximal Humeral (Surgical Or Anatomical Neck) Fracture Includes Internal Fixation When Performed Includes Repair Of Tu Berosity(S) When Performed; |
| 23616-CPT | High | Open Treatment Of Proximal Humeral (Surgical Or Anatomical Neck) Fracture, Includes Internal Fixation, When Performed, Includes Repair Of Tuberosity(S), When Performed; With Proximal Humeral Prosthetic Replacement |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 23616. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 23616 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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