CPT 23472: Total shoulder replacement
What this code means, what it should cost, and how to dispute an overcharge.
Fair Price Reference
What is CPT 23472?
CPT 23472 (Total shoulder replacement) is a orthopedics billing code defined by the American Medical Association. It's used to bill your insurance or you directly for this service.
What CPT 23472 should cost
The Centers for Medicare & Medicaid Services (CMS) pays approximately $1780 for CPT 23472 under the 2025 Physician Fee Schedule. This is what the federal government has determined is a reasonable payment for this service.
Private insurance typically pays 1.2–1.8x Medicare rates ($2136–$3204). Hospital chargemaster prices for CPT 23472 often range from $3500 to $15000 — a markup of 2x to 8.4x over Medicare.
Common overcharges on CPT 23472
Billing diagnostic arthroscopy (29870) alongside therapeutic arthroscopy in the same knee. Billing post-operative office visits during the 90-day global surgical period for major procedures. Billing both closed and open fracture treatment for the same bone. Implant and hardware charges marked up 5-10× above cost.
About Orthopedics billing
Orthopedic procedures — joint surgeries, fracture repairs, spine operations, and arthroscopy — are among the highest-billed categories in medicine. Facility fees, implant markups, and bundled post-operative care create frequent billing disputes.
Request the operative report — it documents exactly what was performed. For arthroscopy, verify that diagnostic and therapeutic codes are not both billed. For fracture care, confirm only one treatment method (closed or open) is charged. Check that follow-up visits within the global period are not separately billed.
How to dispute a CPT 23472 overcharge
- Request the itemized bill. You are entitled to a detailed line-by-line bill showing every CPT code billed. Ask in writing.
- Compare to Medicare allowable. If the charge exceeds 150% of Medicare ($2670), you have grounds to dispute.
- Request documentation. For E&M codes, ask for the visit note. For procedures, ask for the operative report. The documentation must justify the code billed.
- Send a formal dispute letter. Cite the specific discrepancy between the documentation and the code. Reference Medicare rates and NCCI edits where applicable.
- Follow up in writing. Give the provider 30 days to respond. If they don't, escalate to the state attorney general and insurance commissioner.
Got CPT 23472 on your bill?
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