No office rate
Choose 23472 when both humeral and glenoid surfaces are replaced. Choose 23470 for replacement limited to the humeral side.
On this page
CMS RVU26D · Effective 2026-10-01
23472 Shoulder arthroplasty Medicare reimbursement rates in Hawaii
Report this service for primary total shoulder arthroplasty replacing both the humeral and glenoid surfaces, including conventional or reverse-design constructs. Compare 23472 office and facility rates across CMS payment localities in Hawaii.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 23472 in Hawaii?
Hawaii has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1298.43
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Orthopedic surgery
About 23472: Total shoulder joint replacement
Report this service for primary total shoulder arthroplasty replacing both the humeral and glenoid surfaces, including conventional or reverse-design constructs.
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.
CMS billing rules for 23472
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU21.58 · 55%
- Practice expense (office) RVU12.99 · 33%
- Malpractice RVU4.36 · 11%
145.8K
Medicare services in 2024 · #459 by national volume
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.
23472 compared with similar codes
Office rates for Hawaii, from the same CMS release.
No office rate
23473 describes revision of one component of an existing shoulder prosthesis; 23472 describes primary total replacement.
No office rate
23474 is for revision of both components of an existing shoulder prosthesis. Use 23472 for primary replacement of both joint surfaces.
No office rate
23412 repairs a chronic rotator cuff tear rather than replacing the glenohumeral joint surfaces.
Compare 23472 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$1298.43
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 23472 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
2,211
- Code
- 23472
- Physician work
- 21.58
- Practice expense
- 12.99
- Malpractice
- 4.36
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 21.58 | × 1.000 | 21.5800 |
| Practice expense | 12.99 | × 1.137 | 14.7696 |
| Malpractice | 4.36 | × 0.579 | 2.5244 |
| Total RVUs | 38.8741 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$1298.43
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 21.58 | 1 |
| Practice expense | 12.99 | 1.137 |
| Malpractice | 4.36 | 0.579 |
(21.58 × 1 + 12.99 × 1.137 + 4.36 × 0.579) × $33.4009 = $1298.43
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
2,20823465,,Repair shoulder capsule,A,,15.89,11.41,NA,11.41,,3.38,30.68,30.68,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,20923466,,Repair shoulder capsule,A,,15.41,12.43,NA,12.43,,3.14,30.98,30.98,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,21023470,,Reconstruct shoulder joint,A,,17.44,11.57,NA,11.57,,3.56,32.57,32.57,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,21123472,,Reconstruct shoulder joint,A,,21.58,12.99,NA,12.99,,4.36,38.93,38.93,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,21223473,,Revis reconst shoulder joint,A,,24.38,13.85,NA,13.85,,4.89,43.12,43.12,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,21323474,,Revis reconst shoulder joint,A,,26.53,14.56,NA,14.56,,5.38,46.47,46.47,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,21423480,,Revision of collar bone,A,,11.25,9.22,NA,9.22,,2.40,22.87,22.87,0,090,0.10,0.69,0.21,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014