How much does Medicare pay for CPT 23412?

Medicare allowed an average of $1115.32 per service and paid $885.81 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $5516.83, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 23412?

Repair of chronic torn shoulder rotator cuff. It was billed 2,855 times to 2,817 Medicare beneficiaries by 164 providers in 2024.

Which specialty bills 23412 most?

Orthopedic Surgery, with 1,372 services from 80 clinicians. Next are Ambulatory Surgical Center, Physician Assistant, Nurse Practitioner.

CPT 23412

Repair of chronic torn shoulder rotator cuff

$1115.32Medicare-allowed amount per service, averaged across 2,855 services

Providers submitted

$5516.83

Asking price, not received

Medicare allowed

$1115.32

The fee schedule figure

Medicare paid

$885.81

Balance is patient coinsurance

Providers submitted an average of $5516.83 for this code and Medicare allowed $1115.32 — 4.9× 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 $885.81 (79%); the rest is the patient’s coinsurance and deductible.

Services: 2,855
Beneficiaries: 2,817
Providers billing it: 164
Total allowed: $3,184,239

What Medicare pays for CPT 23412

Across 2,855 services billed by 164 providers to 2,817 beneficiaries, Medicare allowed an average of $1115.32 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 23412

Specialty	Services	Beneficiaries	Avg allowed	Providers
Orthopedic Surgery	1,372	1,351	$746.09	80
Ambulatory Surgical Center	780	774	$2607.90	41
Physician Assistant	518	510	$101.05	31
Nurse Practitioner	105	103	$92.79	6
Sports Medicine	44	43	$806.81	3
Hand Surgery	36	36	$801.27	3

23412 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	541	$1288.71	$1084.34	22
North Carolina	135	$839.90	$703.77	10
Texas	134	$668.71	$565.37	9
Oregon	130	$1270.93	$999.44	3
Alaska	129	$1350.69	$1009.25	7
Indiana	113	$1351.52	$1114.79	8
California	109	$1816.63	$1333.85	5
Montana	107	$1296.52	$1100.51	7
Tennessee	97	$1440.78	$1231.75	5
Nebraska	89	$295.11	$250.95	4
Pennsylvania	87	$803.95	$683.14	7
Delaware	83	$857.29	$671.37	5
Mississippi	81	$856.70	$788.49	5
Iowa	77	$2152.07	$1814.61	5
North Dakota	76	$1053.93	$942.88	5
Arizona	68	$946.19	$756.33	4
Nevada	65	$1182.28	$907.81	4
Missouri	60	$800.05	$657.27	4
Utah	58	$1314.55	$1098.70	3
Colorado	53	$1205.18	$960.47	3
Idaho	48	$1243.16	$958.99	3
Kansas	47	$779.24	$666.99	2
Washington	44	$1525.57	$1116.07	3
Georgia	41	$587.14	$469.33	3
South Carolina	40	$1172.15	$986.49	3
Oklahoma	39	$514.58	$422.64	2
Connecticut	39	$1939.99	$1429.90	3
South Dakota	38	$560.50	$473.35	3
Hawaii	28	$420.34	$337.65	2
Arkansas	28	$452.56	$403.84	2
Alabama	26	$215.50	$190.32	2
West Virginia	25	$501.77	$390.16	2
New Mexico	22	$1489.51	$1243.42	2
Louisiana	18	$742.07	$673.75	1
Minnesota	16	$821.71	$641.24	1
Maine	15	$821.93	$670.69	1
Kentucky	14	$806.01	$649.27	1
District of Columbia	13	$658.84	$530.43	1
Michigan	11	$797.19	$688.69	1
Ohio	11	$843.35	$646.73	1

Related codes

23472Prosthetic repair of shoulder joint$1950.90
23430Anchoring of biceps tendon$852.08
23405Incision of shoulder tendon$343.69

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.