How Much Does Open Shoulder Surgery (Rotator Cuff Repair) Cost?
Also known as: Reconstruct shoulder joint (CPT 23472)
Total shoulder replacement (arthroplasty), replacing the damaged shoulder joint with artificial components.
The total estimated cost of Open Shoulder Surgery (Rotator Cuff Repair) (CPT 23472) is $18,982 to $52,726, including hospital fees, anesthesia, and supplies. The surgeon's Medicare fee alone is $1,300. Average Medicare total payment: $21,091.
Total Estimated Cost of Care
This estimate includes hospital facility fees, anesthesia, implants, and supplies for an inpatient hospital stay. Based on CMS data for MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES (DRG 483), the average Medicare total payment is $21,091.
Patient Guide: Open Shoulder Surgery (Rotator Cuff Repair)
What you need to know before your appointment
What to Expect
Under general anesthesia, the surgeon replaces the ball and socket of the shoulder joint with metal and plastic components. Hospital stay is typically 1-2 days.
How Long Does It Take?
2-3 hours
Common Reasons Doctors Order This
Severe shoulder arthritis, shoulder fracture in elderly patient, failed previous shoulder surgery, avascular necrosis
How to Prepare
Fast before surgery. Arrange help at home for 4-6 weeks. You will wear a sling and have lifting restrictions. Physical therapy is essential.
Procedures Commonly Done Together
These procedures are frequently performed alongside Reconstruct shoulder joint
How to Reduce Your Cost for Reconstruct shoulder joint
Practical tips that can save you hundreds or thousands of dollars
- 1 Ask about cash-pay discounts
Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.
- 2 Compare facility vs. office setting costs
Some procedures cost significantly less in an office setting than a hospital. Ask your provider about options.
- 3 Shop around — costs vary significantly
Costs can vary 2-3x between providers in the same city. Get quotes from multiple facilities.
How is the Price Calculated?
Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.
Payment = Total RVU (38.93) x CF ($33.40) = $1,300
Related Procedures
Similar procedures in the same category or body system
Frequently Asked Questions
How much does Reconstruct shoulder joint cost?
The Medicare facility rate for Reconstruct shoulder joint is $1,300. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).
How much does Reconstruct shoulder joint cost without insurance?
Without insurance, the cost of Reconstruct shoulder joint can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.
Does insurance cover Reconstruct shoulder joint?
Most commercial health insurance plans and Medicare cover Reconstruct shoulder joint when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.
Why does the cost vary so much by location?
Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.