What the whole shoulder replacement revision costs
Redo surgery on a shoulder replacement: both parts (23474) or one part (23473). Every bill that usually comes with it, who sends it, and where each number comes from.
National Medicare amounts (payment-area and wage adjustments at 1.0). Facility: OPPS Addendum B, July 2026 (national unadjusted rate); local = rate × (0.6 × wage index + 0.4); ASC Addendum AA, July 2026 (national rate); local = rate × (0.5 × wage index + 0.5); device-intensive (J8) codes keep the device portion unadjusted; FY 2026 IPPS final rule CMS-1833-F, Table 5; standard amounts from Tables 1A-1E; local = weight × (labor × wage index + non-labor + capital × wage index^0.6848). Leaves out teaching (IME), safety-net (DSH) and outlier add-ons. Surgeon: CMS Physician Fee Schedule CY2026 (RVU26D). Anesthesia: CMS base units × the CY2026 anesthesia conversion factor, with an assumed case time. An educational estimate, not a quote.
Line by line (hospital stay)
Hospital stay, MS-DRG 483: $20,170. Billed by The hospital. CMS FY2026 IPPS: MS-DRG 483 weight 2.7719; FY 2026 IPPS final rule CMS-1833-F, Table 5; standard amounts from Tables 1A-1E; local = weight × (labor × wage index + non-labor + capital × wage index^0.6848). Leaves out teaching (IME), safety-net (DSH) and outlier add-ons.
Surgeon, CPT 23474: $1,552. Billed by The surgeon's group. CMS Physician Fee Schedule CY2026 (RVU26D, Oct 2026 release), facility rate, PFS locality national (GPCI 1.0)
Assistant surgeon (modifier 80): $248. Billed by The assistant surgeon. Medicare Claims Processing Manual, Ch. 12, §20.4.3: assistant-at-surgery (modifiers 80/81/82) = 16% of the surgeon's fee schedule amount; a PA, NP or CNS assisting (modifier AS) = 85% of that, 13.6%. Indicator from the RVU26D ASST SURG column (0 = only with documented medical necessity, 1 = not paid, 2 = paid).
Anesthesia, ASA code 01638: $512. Billed by The anesthesia group. CMS anesthesia base units (CY2022 file, unchanged for CY2026) + CY2026 anesthesia conversion factor $20.49754 for the nation (ANES2026, RVU26D). Code mapping is ours, from the ASA code descriptors.
Consultation visit (new patient): $177. Billed by The surgeon's group. CMS PFS CY2026 (RVU26D), non-facility (office) rate, CPT 99204
X-rays before surgery: $36. Billed by Office or imaging center. CMS PFS CY2026 (RVU26D), non-facility (office) rate, CPT 73030
Blood count (CBC): $8. Billed by The lab. CMS Clinical Laboratory Fee Schedule CY2026 Q4 (26CLABQ4), national limit
Basic metabolic panel: $8. Billed by The lab. CMS Clinical Laboratory Fee Schedule CY2026 Q4 (26CLABQ4), national limit
Pre-op ECG: $15. Billed by Office or hospital. CMS PFS CY2026 (RVU26D), non-facility (office) rate, CPT 93000
Follow-up X-ray: $36. Billed by Office or imaging center. CMS PFS CY2026 (RVU26D), non-facility (office) rate, CPT 73030
Physical therapy, 12 visits: $795. Billed by The therapy clinic. CMS PFS CY2026 (RVU26D), non-facility rates for 97161 and 97110
Questions
How much does a shoulder replacement revision cost in total, with every bill?
At national Medicare rates for 2026, the whole shoulder replacement revision comes to about $23,559 in a hospital stay, counting the facility, the surgeon, anesthesia and typical care before and after. Commercial plans usually pay more; local rates differ by area.
Why do I get separate bills for a shoulder replacement revision?
The hospital bills for the facility; the surgeon's group bills for the operation (Surgeon, CPT 23474, about $1,552 from Medicare nationally); the anesthesia group bills by base units plus time (about $512 at our default time); labs, imaging, pathology and therapy each come from their own provider.
What does the surgeon's fee include?
90-day global: the fee covers the operation plus the visit the day before and routine follow-up visits for 90 days.