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CPT 23412: Open Surgical Repair of Chronic Rotator Cuff Tear
CPT code 23412 represents an open surgical repair for chronic or persistent tears of the rotator cuff, a group of muscles and tendons that stabilize the shoulder joint. This operative procedure is clinically significant because rotator cuff pathology is a common source of shoulder pain and disability and open repair remains a durable option when tendon degeneration or tear chronicity limit arthroscopic approaches. Nationally, the code is used to classify and bill inpatient and outpatient surgical care for rotator cuff reconstruction.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise presentation of what 23412 denotes clinically and operationally, which payers accept and process claims for this service, and how it fits into surgical service lines. The publication includes benchmark context for utilization and reimbursement patterns, common billing and coding companions, and relevant clinical indications tied to rotator cuff tear diagnoses.
This summary is intended for health system administrators, billing professionals, and policy analysts seeking a clear, national-level reference on the clinical and billing identity of CPT code 23412, how it aligns with surgical service types and sites of care, and what to expect when classifying rotator cuff open repairs in administrative data.
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Billing Code Overview
CPT code 23412 describes an open surgical repair of a chronic or persistent rotator cuff tear in the shoulder. The procedure involves direct visualization and operative repair of one or more torn rotator cuff tendons to restore shoulder stability and function.
Service Type: Open orthopedic surgical procedure — rotator cuff repair
Typical Site of Service: Hospital operating room or ambulatory surgical center
National Reimbursement Benchmarks
National means show Medicare at $806.1 versus BUCA (commercial aggregate) at $3,111.3, indicating BUCA’s average reimbursement is roughly four times Medicare’s. That gap highlights a common commercial-to-Medicare divergence: Medicare centers near mid-range public-sector payment while commercial aggregates like BUCA sit substantially higher, affecting overall market pricing benchmarks.
Dispersion measured by the interquartile range (P75–P25) varies notably: Blue Cross Blue Shield has the widest IQR at $5,118.1 ($6,910.3–$1,792.2), followed by BUCA at $3,298.7 ($4,607.0–$1,308.3). UnitedHealth Group’s IQR is $902.5 ($1,883.5–$981.0) and Cigna’s is $980.0 ($1,846.0–$867.0). Aetna is the tightest among those with full quartiles at $714.0 ($878.0–$141.2). These spreads indicate where commercial contract rates cluster tightly versus where they are highly variable.