CPT 23630 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 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 23630 |
| Medicaid Fee Schedule | View Medicaid rates for 23630 |
National average reimbursement for CPT 23630 by major payers:
$1,056.47
$1,019.89
$1,071.76
$1,256.35
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 23630 | $6759.00 | 1578741849 - SCOTT AND WHITE HOSPITAL, BAYLOR SCOTT & WHITE MEDICAL CENTER - TAYLOR | 741595711 - (TX) SCOTT & WHITE HOSPITAL-TAYLOR | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23630 | $6791.00 | 1184195877 - ALPINE SURGICENTER, LLC | 204038061 | AK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23630 | $3500.00 | 1275516718 - PREMIER SURGICAL CENTER, INC | 223717100 - PREMIER SURGICAL CENTER, LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23630 | $6365.00 | 1386277069 - SOUTHWEST ENDOSCOPY LLC | 843623972 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23630 | $1359.68 | 1174788756 - REBECCA HOPPER | 350593390 - DEACONESS HOSPITAL INC | IN | Pediatrics Physician (208000000X) |
United | 23630 | $675.00 | 1417118241 - DIGESTIVE HEALTH COMPLEX,INC | 262808532 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23630 | $5500.00 | 1972153997 - EASTERN PENNSYLVANIA ENDOSCOPY CENTER, LLC | 842257961 - (PA) EASTERN PENNSYLVANIA ENDOSCOPY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23630 | $1109.61 | 1285746263 - ORTHOPEDICS SURGICAL CENTER OF THE NORTH SHORE LLC | 10731399 - (MA) ORTHOPEDIC SURGICAL CENTER OF THE NORTH SHORE | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23630 | $3000.00 | 1659463669 - ARUSHA LLC, THE SURGERY CENTER OF CHESTER COUNTY | 233076222 - (PA) ARUSHA LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23630 | $2526.00 | 1023057916 - PHYSICIANS DAY SURGERY CENTER | 710623198 | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23630 | $4072.00 | 1447949706 - BAPTIST HEALTH SURGERY CENTER, LLC, BAPTIST HEALTH SURGERY CENTER AT BOCA RATON RESEARCH PARK | 650663357 - (FL) BAPTIST HEALTH SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23630 | $3240.00 | 1437794625 - VANCE THOMPSON VISION SURGERY CENTER BILLINGS, LLC | 455323939 | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23630 | $6588.00 | 1821036138 - GAMMA SURGERY CENTER LLC | 270128900 - (PA) GAMMA SURGERY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23630 | $5125.00 | 1225531544 - ANNE ARUNDEL-SCA SURGICENTER, LLC | 824763728 - (MD) ANNE ARUNDELSCA SURGICENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 23630 | $1750.00 | 1649407180 - PAIN MDS INC | 270279190 - (AZ) PAIN MDS INC | 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 23630 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 23630 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 23630 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 | Closed Treatment Of Proximal H, Closed Treatment Of Proximal Humeral (Surgical Or Anatomicalneck) Fracture Without Manipulation Closed Treatment Of Proximal Humeral (Surgical Or Anatomical |
| 23605-CPT | Moderate | Cltx Prx Hmrl Fx Mnpj Tract, Closed Treatment Of Proximal Humeral Surgical Or Anatomical Neck Fracture With Manipulation With Or Without Skeletal Traction |
| 23620-CPT | Moderate | Closed Treatment Of Greater Hu, Closed Treatment Of Greater Humeral Tuberosity Fracturewithout Manipulation Closed Treatment Of Greater Humeral Tuberosity Fracture |
| 23630-CPT | High | Repair Broken Shoulder, Surgery To Repair A Broken Shoulder Involving The End Of The Bone In The Upper Arm (Humerus). This May Involve The Use Of Wires Pins Plates Rings Or Screws To Hold The Bone Together. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 23630. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 23630 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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