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Billing code 23472: Shoulder arthroplastyMedicare rate & RVUs

Report this service for primary total shoulder arthroplasty replacing both the humeral and glenoid surfaces, including conventional or reverse-design constructs.

CMS RVU26DEffective Oct 1, 2026109 payment localities145.8K Medicare services in 2024

Medicare pays $1,300.30 for 23472 nationally in a facility.

Medicare rate · 23472

Shoulder arthroplasty

Swap in your local Medicare rate.

Work RVUs
21.58
Total RVUs
38.93
Global days
090

National rate · 2026

$1,300.30

Facility setting, before claim adjustments.

See every locality for 23472 → · Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

On this page 10 sections
  1. Medicare rate
  2. What 23472 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 23472 covers

An orthopedic surgeon replaces the humeral and glenoid surfaces of the shoulder’s glenohumeral joint with prosthetic components. The procedure is performed in an operating room, commonly for advanced shoulder arthritis or other joint damage when total replacement is chosen. Both conventional and reverse-design total shoulder constructs are reported with this code; the operative report should identify the replacement performed and the components implanted.

Report the primary total replacement, rather than a humeral-side-only replacement or a revision procedure. Documentation should support the condition treated, the operative approach, and replacement of both joint surfaces. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 23472 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

23472 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,182.86
Alaska*Unavailable$1,623.51
ArizonaUnavailable$1,265.88
ArkansasUnavailable$1,168.49
AtlantaUnavailable$1,338.67
AustinUnavailable$1,310.30
BakersfieldUnavailable$1,298.70
Baltimore/Surr. CntysUnavailable$1,378.02
BeaumontUnavailable$1,250.91
BrazoriaUnavailable$1,270.12

23472 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
23472 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 23472 rate is calculated

Each of 23472’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 23472

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 21.58Practice expense 12.99Malpractice 4.36

38.9300 adjusted RVUs×$33.4009 conversion factor=$1,300.30

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 23472

23472 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 23472

Shoulder arthroplasty

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 23472

Shoulder arthroplasty

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

23472 without 50 · national facility

$1,300.30

Shoulder arthroplasty

23472-50 · Bilateral: 150%

$1,950.45

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

23472 compared with similar codes

Compare codes

23472 vs 23470 vs 23473 vs 23474 vs 23412: national Medicare rates

Swap in your local Medicare rate.

  • 23472
    Shoulder arthroplasty · 21.58 wRVU
    —
  • 23470
    Shoulder arthroplasty · 17.44 wRVU
    —
  • 23473
    Shoulder revision · 24.38 wRVU
    —
  • 23474
    Shoulder revision · 26.53 wRVU
    —
  • 23412
    Rotator cuff repair · 11.63 wRVU
    —

How to choose

23470Shoulder arthroplasty
Choose 23472 when both humeral and glenoid surfaces are replaced. Choose 23470 for replacement limited to the humeral side.
23473Shoulder revision
23473 describes revision of one component of an existing shoulder prosthesis; 23472 describes primary total replacement.
23474Shoulder revision
23474 is for revision of both components of an existing shoulder prosthesis. Use 23472 for primary replacement of both joint surfaces.
23412Rotator cuff repair
23412 repairs a chronic rotator cuff tear rather than replacing the glenohumeral joint surfaces.

Codes related to 23472

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 23472
CodeHow it relatesNational office range
Same family
23470Shoulder arthroplastyHumeral-side shoulder replacement without replacement of the glenoid surface.No office rate
Used instead
23473Shoulder revisionRevision code when the humeral or glenoid component is revised.No office rate
23474Shoulder revisionRevision code when both shoulder replacement components are revised.No office rate

23472 billing questions

How does this differ from 23470?

Code 23472 represents replacement of both the humeral and glenoid surfaces. Code 23470 represents replacement on the humeral side without glenoid replacement.

Which code applies when a shoulder prosthesis is revised?

Use 23473 for revision of one component and 23474 when both components are revised. Code 23472 describes a primary total replacement, not revision of an existing prosthesis.

Does the code include both prosthetic components?

Yes. The service is the total shoulder replacement of the humeral and glenoid surfaces; it is not reported as separate replacement codes for each surface.

What postoperative care is included in the global period?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

How is this paid when another procedure is performed in the same session?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 23472PPRRVU2026_Oct_nonQPP.csv, line 2,211 (RVU26D)

Open CMS sourceHow we calculate rates

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