No office rate
Choose 23470 when the humeral side is replaced and the native glenoid is retained. Choose 23472 when both sides of the joint are replaced.
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CMS RVU26D · Effective 2026-10-01
23470 Shoulder arthroplasty Medicare reimbursement rates in Illinois
Shoulder hemiarthroplasty replaces the humeral joint surface while retaining the native glenoid, typically for selected cases of shoulder arthritis or humeral head damage. Compare 23470 office and facility rates across CMS payment localities in Illinois.
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 23470 in Illinois?
Illinois has 4 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 4 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1121.19–$1247.86
4 of 4 localities have a supported rate.
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.
Where 23470 pays more and less in Illinois
Orthopedic surgery
About 23470: Shoulder hemiarthroplasty
Shoulder hemiarthroplasty replaces the humeral joint surface while retaining the native glenoid, typically for selected cases of shoulder arthritis or humeral head damage.
An orthopedic surgeon performs this operation to replace the humeral side of the glenohumeral joint while leaving the patient’s natural glenoid in place. It may be selected for severe shoulder arthritis or substantial humeral head damage when the surgeon plans a hemiarthroplasty rather than replacement of both joint surfaces. The procedure is generally performed in an operating room, with the operative report documenting the condition treated and the components replaced or retained.
Report the code for the hemiarthroplasty, not for a total shoulder replacement or revision of an existing prosthesis. CMS assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery payment is not permitted.
CMS billing rules for 23470
- 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 RVU17.44 · 54%
- Practice expense (office) RVU11.57 · 36%
- Malpractice RVU3.56 · 11%
1.4K
Medicare services in 2024 · #2703 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.
23470 compared with similar codes
Office rates for Illinois, from the same CMS release.
No office rate
23473 describes revision of one component of an existing shoulder prosthesis; 23470 describes a primary hemiarthroplasty, not prosthesis revision.
No office rate
23474 is for revision involving both components of an existing shoulder prosthesis. It is not the primary replacement of the humeral side represented by 23470.
Compare 23470 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.
4 of 4 payment localities
Chicago →
Office / nonfacility
Unavailable
Facility
$1247.86
East St. Louis →
Office / nonfacility
Unavailable
Facility
$1177.52
Rest Of Illinois →
Office / nonfacility
Unavailable
Facility
$1121.19
Suburban Chicago →
Office / nonfacility
Unavailable
Facility
$1194.18
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23470 billing questions
How does this differ from 23472?
This code represents replacement of the humeral side while retaining the native glenoid. Report 23472 when the operation replaces both sides of the shoulder joint.
What documentation supports hemiarthroplasty rather than total shoulder replacement?
The operative report should establish the shoulder condition treated and identify that the humeral joint surface was replaced while the native glenoid was retained.
Does the 90-day global period include postoperative visits?
Yes. CMS includes the day-before preoperative visit and 90 days of related postoperative care in the global period.
How is bilateral hemiarthroplasty handled?
When the procedure is performed bilaterally, CMS pays the service reported with modifier 50 at 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery payment is not permitted.
What happens when another procedure is performed during the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
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.
2,20723462,,Repair shoulder capsule,A,,15.33,10.67,NA,10.67,,3.26,29.26,29.26,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,20823465,,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