How much does Medicare pay for CPT 23395?

Medicare allowed an average of $517.85 per service and paid $413.05 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $4401.42, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 23395?

Relocation of one muscle of shoulder or upper arm. It was billed 2,300 times to 2,264 Medicare beneficiaries by 78 providers in 2024.

Does 23395 pay differently in an office than a hospital?

Yes. The allowed amount averaged $692.32 in an office setting and $515.23 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 23395 most?

Orthopedic Surgery, with 1,452 services from 46 clinicians. Next are Physician Assistant, Hand Surgery, Ambulatory Surgical Center.

CPT 23395

Relocation of one muscle of shoulder or upper arm

$517.85Medicare-allowed amount per service, averaged across 2,300 services

Providers submitted

$4401.42

Asking price, not received

Medicare allowed

$517.85

The fee schedule figure

Medicare paid

$413.05

Balance is patient coinsurance

Providers submitted an average of $4401.42 for this code and Medicare allowed $517.85 — 8.5× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $413.05 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $692.32
Hospital / facility: $515.23

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 34 services were billed in an office setting and 2,266 in a facility.

Services: 2,300
Beneficiaries: 2,264
Providers billing it: 78
Total allowed: $1,191,055

What Medicare pays for CPT 23395

Across 2,300 services billed by 78 providers to 2,264 beneficiaries, Medicare allowed an average of $517.85 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 23395

Specialty	Services	Beneficiaries	Avg allowed	Providers
Orthopedic Surgery	1,452	1,429	$626.90	46
Physician Assistant	614	604	$96.78	20
Hand Surgery	75	75	$671.71	3
Ambulatory Surgical Center	60	60	$2131.55	3
Nurse Practitioner	57	57	$86.41	3
Sports Medicine	26	25	$713.03	2
Plastic and Reconstructive Surgery	16	14	$1226.77	1

23395 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	389	$533.38	$416.62	9
Texas	285	$346.06	$275.05	6
Oregon	245	$484.87	$402.92	6
Delaware	204	$418.72	$338.80	3
Connecticut	187	$618.35	$456.92	6
Pennsylvania	183	$775.27	$610.42	8
Maryland	108	$618.79	$469.72	7
Arizona	98	$365.47	$295.65	4
New York	93	$637.49	$406.85	5
Minnesota	74	$573.67	$456.28	4
California	74	$712.30	$524.55	5
West Virginia	72	$421.44	$329.05	2
District of Columbia	58	$772.20	$523.78	2
Illinois	42	$264.97	$191.80	2
Michigan	37	$96.71	$80.28	1
Massachusetts	34	$692.32	$504.31	1
Ohio	27	$97.01	$80.54	1
Alaska	25	$666.40	$538.36	1
South Carolina	15	$641.73	$505.22	1
Tennessee	14	$581.28	$504.59	1
New Jersey	13	$111.39	$68.52	1
Louisiana	12	$600.72	$505.08	1
Colorado	11	$641.01	$505.76	1

Related codes

23350Injection of contrast for imaging of shoulder joint$135.99

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.