How much does Medicare pay for CPT 23472?

Medicare allowed an average of $1950.90 per service and paid $1552.29 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $8491.39, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 23472?

Prosthetic repair of shoulder joint, total shoulder. It was billed 111,038 times to 109,051 Medicare beneficiaries by 4,044 providers in 2024.

Does 23472 pay differently in an office than a hospital?

Yes. The allowed amount averaged $984.60 in an office setting and $1957.94 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 23472 most?

Orthopedic Surgery, with 59,191 services from 2,070 clinicians. Next are Physician Assistant, Ambulatory Surgical Center, Sports Medicine.

CPT 23472

Prosthetic repair of shoulder joint, total shoulder

$1950.90Medicare-allowed amount per service, averaged across 111,038 services

Providers submitted

$8491.39

Asking price, not received

Medicare allowed

$1950.90

The fee schedule figure

Medicare paid

$1552.29

Balance is patient coinsurance

Providers submitted an average of $8491.39 for this code and Medicare allowed $1950.90 — 4.4× 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 $1552.29 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $984.60
Hospital / facility: $1957.94

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 803 services were billed in an office setting and 110,235 in a facility.

Services: 111,038
Beneficiaries: 109,051
Providers billing it: 4,044
Total allowed: $216,624,034

What Medicare pays for CPT 23472

Across 111,038 services billed by 4,044 providers to 109,051 beneficiaries, Medicare allowed an average of $1950.90 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 23472

Specialty	Services	Beneficiaries	Avg allowed	Providers
Orthopedic Surgery	59,191	58,026	$1369.97	2,070
Physician Assistant	30,963	30,486	$191.53	1,245
Ambulatory Surgical Center	8,956	8,810	$13,214	325
Sports Medicine	4,590	4,510	$1406.92	147
Nurse Practitioner	4,050	3,986	$186.63	152
Hand Surgery	2,662	2,615	$1398.86	95
Obstetrics & Gynecology	226	222	$484.27	2
General Surgery	140	140	$446.94	2
Certified Clinical Nurse Specialist	70	68	$191.92	1
Family Practice	69	68	$218.12	2
Osteopathic Manipulative Medicine	46	45	$1348.95	1
General Practice	42	42	$214.84	1
Emergency Medicine	33	33	$1413.93	1

23472 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	9,732	$2125.60	$1735.88	292
California	6,690	$1979.78	$1422.53	222
Texas	6,059	$1424.95	$1171.77	229
Ohio	4,972	$2240.44	$1903.48	171
Pennsylvania	4,063	$1648.06	$1325.68	158
Virginia	3,908	$2087.13	$1727.82	124
North Carolina	3,899	$1929.88	$1624.34	168
Arizona	3,879	$2200.76	$1797.48	133
Illinois	3,773	$2199.94	$1719.61	150
New York	3,403	$1966.80	$1529.04	122
Colorado	3,232	$1492.31	$1190.94	106
Tennessee	3,183	$2694.56	$2426.72	105
Washington	3,057	$2147.05	$1627.27	112
Indiana	3,048	$1806.94	$1534.70	132
Massachusetts	2,836	$1602.07	$1232.98	89
South Carolina	2,833	$2125.48	$1819.15	98
Michigan	2,818	$2561.08	$2106.39	108
Missouri	2,598	$2020.13	$1723.61	88
Kansas	2,254	$1150.32	$1010.00	75
New Jersey	2,086	$1787.70	$1339.28	76
Maryland	2,080	$1794.72	$1383.04	67
Kentucky	1,978	$1507.81	$1281.31	67
Georgia	1,970	$1957.29	$1607.02	87
Wisconsin	1,773	$1688.28	$1439.73	78
Oregon	1,769	$2978.46	$2334.88	60
Oklahoma	1,681	$1198.87	$1006.54	69
Iowa	1,599	$1877.55	$1628.21	65
Utah	1,583	$2318.34	$1942.38	62
Nebraska	1,573	$881.86	$761.86	53
Minnesota	1,537	$1808.89	$1459.08	71
Connecticut	1,316	$2764.10	$2067.54	55
Louisiana	1,291	$1352.21	$1152.56	48
Arkansas	1,208	$1228.64	$1077.74	53
Idaho	1,163	$1659.20	$1434.07	48
Montana	1,139	$2487.96	$2072.46	38
Alabama	1,112	$1049.38	$934.96	59
Mississippi	1,035	$4328.04	$3969.78	41
South Dakota	1,031	$793.83	$676.80	33
Nevada	1,026	$2186.60	$1778.16	35
New Hampshire	755	$1729.53	$1390.14	28
Wyoming	574	$2035.61	$1661.53	23
North Dakota	571	$2025.04	$1722.34	24
Delaware	564	$1268.51	$1003.73	14
Alaska	514	$3944.82	$2877.22	22
New Mexico	450	$3569.13	$3084.19	23
Maine	432	$943.97	$769.31	20
West Virginia	371	$1524.17	$1315.22	18
Rhode Island	292	$2660.37	$2123.73	11
Vermont	157	$1058.27	$891.87	8
District of Columbia	129	$1617.89	$1123.62	4
Hawaii	42	$1340.43	$1129.49	2

Related codes

23430Anchoring of biceps tendon$852.08
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.