How much does Medicare pay for CPT 23430?

Medicare allowed an average of $852.08 per service and paid $678.70 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $4434.09, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 23430?

Anchoring of biceps tendon. It was billed 21,035 times to 20,747 Medicare beneficiaries by 941 providers in 2024.

Does 23430 pay differently in an office than a hospital?

Yes. The allowed amount averaged $418.41 in an office setting and $854.67 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 23430 most?

Orthopedic Surgery, with 10,948 services from 460 clinicians. Next are Physician Assistant, Ambulatory Surgical Center, Sports Medicine.

CPT 23430

Anchoring of biceps tendon

$852.08Medicare-allowed amount per service, averaged across 21,035 services

Providers submitted

$4434.09

Asking price, not received

Medicare allowed

$852.08

The fee schedule figure

Medicare paid

$678.70

Balance is patient coinsurance

Providers submitted an average of $4434.09 for this code and Medicare allowed $852.08 — 5.2× 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 $678.70 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $418.41
Hospital / facility: $854.67

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 125 services were billed in an office setting and 20,910 in a facility.

Services: 21,035
Beneficiaries: 20,747
Providers billing it: 941
Total allowed: $17,923,503

What Medicare pays for CPT 23430

Across 21,035 services billed by 941 providers to 20,747 beneficiaries, Medicare allowed an average of $852.08 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 23430

Specialty	Services	Beneficiaries	Avg allowed	Providers
Orthopedic Surgery	10,948	10,780	$389.58	460
Physician Assistant	5,089	5,025	$53.08	238
Ambulatory Surgical Center	3,274	3,240	$3949.07	159
Sports Medicine	712	702	$390.85	38
Nurse Practitioner	557	550	$51.89	26
Hand Surgery	328	326	$393.35	16
Certified Clinical Nurse Specialist	43	42	$53.53	1
Obstetrics & Gynecology	39	38	$456.34	1
General Practice	28	28	$56.60	1
Family Practice	17	16	$59.54	1

23430 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	1,822	$593.94	$487.03	63
Texas	1,735	$697.17	$584.31	76
California	1,681	$918.88	$609.10	69
New York	928	$489.91	$338.19	28
South Carolina	840	$637.38	$545.77	34
North Carolina	821	$993.55	$849.56	46
Ohio	781	$915.16	$844.15	31
Arizona	749	$581.89	$473.29	33
Colorado	715	$1074.66	$856.83	38
New Jersey	633	$658.91	$488.95	20
Washington	577	$1611.67	$1265.06	26
Georgia	571	$1181.60	$1000.58	30
Maryland	542	$639.44	$505.74	29
Idaho	515	$598.76	$513.00	21
Tennessee	512	$1017.52	$888.49	26
Massachusetts	484	$549.89	$414.38	21
Virginia	481	$1564.94	$1292.81	24
Nevada	443	$789.07	$675.49	17
Illinois	428	$1668.78	$1361.87	22
Missouri	366	$463.75	$383.54	19
Kansas	346	$467.74	$398.40	18
Arkansas	342	$734.05	$652.97	16
Nebraska	337	$1022.92	$901.63	11
Connecticut	329	$1086.35	$806.08	16
Michigan	299	$638.36	$516.08	16
Montana	294	$1791.58	$1562.87	17
Oklahoma	283	$681.64	$593.65	13
Indiana	275	$1056.23	$915.67	19
Mississippi	263	$1307.77	$1239.50	10
Kentucky	263	$529.90	$449.64	13
Alabama	250	$421.46	$376.69	14
Delaware	236	$220.22	$178.87	7
Oregon	212	$1876.11	$1444.98	10
Wisconsin	192	$505.42	$420.18	9
Louisiana	192	$520.72	$473.80	11
Utah	171	$1007.65	$872.06	10
Rhode Island	157	$788.61	$631.04	6
New Hampshire	154	$1157.09	$925.44	8
Pennsylvania	137	$260.69	$215.83	7
New Mexico	123	$917.53	$772.50	5
Alaska	122	$2696.15	$2111.19	5
South Dakota	83	$238.91	$201.97	4
Wyoming	73	$1340.82	$1097.94	4
Iowa	67	$1192.11	$1072.83	5
Minnesota	43	$434.52	$341.90	3
North Dakota	41	$1310.47	$1094.77	3
Maine	29	$414.65	$355.72	1
Vermont	25	$339.97	$297.47	1
Hawaii	24	$2297.58	$1802.76	2
West Virginia	23	$2265.86	$2014.86	2
Guam	14	$441.42	$336.44	1
District of Columbia	12	$430.62	$286.86	1

Related codes

23472Prosthetic repair of shoulder joint$1950.90
23412Repair of chronic torn shoulder rotator cuff$1115.32
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.