Cost analysis for CPT 23472 — Prosthetic repair of shoulder joint, total shoulder
Average Medicare Payment
$754.26
2023 data
Total Payments (2023)
$73.2M
Services (2023)
93.2K
Price Change (2014–2023)
-5.8%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2014 | $800.85 | $30.5M | 36.8K | — |
| 2015 | $794.06 | $35.6M | 43.2K | -0.8% |
| 2016 | $787.06 | $40.5M | 49.8K | -0.9% |
| 2017 | $793.37 | $46.4M | 56.5K | +0.8% |
| 2018 | $784.94 | $52.9M | 64.8K | -1.1% |
| 2019 | $790.80 | $61.1M | 74.5K | +0.7% |
| 2020 | $806.08 | $51.9M | 62.5K | +1.9% |
| 2021 | $783.82 | $58.3M | 71.8K | -2.8% |
| 2022 | $768.74 | $64.8M | 81.1K | -1.9% |
| 2023 | $754.26 | $73.2M | 93.2K | -1.9% |
The most expensive state pays 2.2x more than the cheapest for this procedure. DC averages $1310.70 vs ID at $609.00.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| DC | $1310.70 | $184.8K | 141 | 4 |
| AK | $1025.86 | $365.2K | 356 | 17 |
| NY | $1015.89 | $2.9M | 2.8K | 105 |
| RI | $904.08 | $208.8K | 231 | 11 |
| MD | $903.16 | $1.6M | 1.8K | 52 |
| PA | $886.05 | $3.1M | 3.6K | 135 |
| CA | $877.59 | $4.9M | 5.6K | 190 |
| NV | $870.85 | $599.1K | 688 | 25 |
| MA | $866.19 | $2.0M | 2.4K | 80 |
| MS | $846.78 | $635.9K | 751 | 32 |
| IL | $843.74 | $2.7M | 3.2K | 125 |
| MI | $835.55 | $1.8M | 2.2K | 86 |
| NJ | $834.97 | $1.3M | 1.6K | 63 |
| MO | $828.77 | $1.9M | 2.3K | 80 |
| WY | $828.03 | $348.6K | 421 | 18 |
| VT | $812.66 | $130.8K | 161 | 7 |
| MN | $810.79 | $1.2M | 1.4K | 62 |
| GA | $810.27 | $1.7M | 2.0K | 91 |
| CT | $809.86 | $758.0K | 936 | 43 |
| TN | $797.16 | $2.0M | 2.4K | 84 |
| VA | $784.98 | $2.7M | 3.4K | 100 |
| OH | $782.66 | $3.0M | 3.9K | 145 |
| WV | $782.33 | $245.7K | 314 | 13 |
| SC | $781.84 | $1.8M | 2.3K | 85 |
| FL | $780.73 | $6.1M | 7.9K | 238 |
| WA | $777.23 | $2.1M | 2.6K | 99 |
| NH | $775.01 | $447.2K | 577 | 20 |
| KY | $773.84 | $1.3M | 1.7K | 57 |
| LA | $757.28 | $814.8K | 1.1K | 41 |
| NM | $756.40 | $289.7K | 383 | 21 |
| TX | $752.38 | $3.9M | 5.2K | 195 |
| IA | $747.54 | $988.3K | 1.3K | 56 |
| NC | $742.22 | $2.4M | 3.2K | 132 |
| OK | $740.56 | $1.1M | 1.5K | 66 |
| CO | $736.45 | $2.2M | 3.0K | 101 |
| ND | $729.83 | $305.1K | 418 | 17 |
| MT | $728.92 | $600.6K | 824 | 32 |
| AZ | $726.02 | $2.3M | 3.1K | 109 |
| UT | $711.92 | $884.9K | 1.2K | 39 |
| OR | $708.11 | $1.0M | 1.4K | 56 |
| AR | $701.47 | $735.1K | 1.0K | 45 |
| DE | $698.92 | $366.2K | 524 | 12 |
| AL | $671.29 | $770.6K | 1.1K | 54 |
| WI | $668.75 | $992.4K | 1.5K | 62 |
| ME | $659.73 | $299.5K | 454 | 23 |
| IN | $646.42 | $1.7M | 2.6K | 111 |
| KS | $637.88 | $1.3M | 2.0K | 75 |
| SD | $634.94 | $633.7K | 998 | 33 |
| NE | $622.71 | $808.3K | 1.3K | 39 |
| ID | $609.00 | $701.0K | 1.2K | 47 |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Jonathan Levy | Orthopedic Surgery | FL | $260.3K | 211 | $1233.66 |
| Derek Cuff | Orthopedic Surgery | FL | $216.2K | 187 | $1156.03 |
| Ryan Simovitch | Orthopedic Surgery | FL | $214.7K | 176 | $1219.61 |
| Kirk Jensen | Orthopedic Surgery | CA | $185.7K | 142 | $1307.73 |
| Andrew Jawa | Orthopedic Surgery | MA | $181.9K | 146 | $1246.22 |
| Steven Goldberg | Orthopedic Surgery | FL | $180.8K | 147 | $1230.03 |
| Steven Hattrup | Orthopedic Surgery | AZ | $175.5K | 157 | $1117.60 |
| Jacob Deister | Orthopedic Surgery | KS | $150.3K | 142 | $1058.78 |
| Kurt Bormann | Orthopedic Surgery | MO | $150.2K | 141 | $1065.42 |
| Patrick St.Pierre | Sports Medicine | CA | $150.2K | 124 | $1210.97 |
| Eric Ricchetti | Orthopedic Surgery | OH | $148.9K | 135 | $1103.09 |
| Matthew Ramsey | Orthopedic Surgery | PA | $143.6K | 117 | $1227.19 |
| David Weinstein | Orthopedic Surgery | CO | $137.6K | 120 | $1146.58 |
| Sean Grey | Orthopedic Surgery | CO | $136.2K | 119 | $1144.92 |
| J Michael Wiater | Orthopedic Surgery | MI | $134.9K | 114 | $1183.36 |
| Julia Lee | Orthopedic Surgery | CA | $134.8K | 115 | $1172.11 |
| Zachary Leitze | Orthopedic Surgery | UT | $133.5K | 122 | $1094.40 |
| John Sperling | Orthopedic Surgery | MN | $132.5K | 122 | $1085.69 |
| John Brown | Orthopedic Surgery | AZ | $132.2K | 117 | $1129.79 |
| Hafiz Kassam | Orthopedic Surgery | CA | $131.3K | 106 | $1239.10 |
The data suggests significant pricing inconsistencies for CPT 23472. With a 2.2x price gap between the most and least expensive states, geography plays an outsized role in what Medicare pays for this procedure.
While costs have decreased 5.8% since 2014, the wide state-by-state variation suggests the pricing formula may not adequately account for regional differences.
This analysis is based on publicly available CMS data and does not account for patient complexity, comorbidities, or facility-specific factors that may justify pricing differences.
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.