Question 1

Does Medicare cover rotator cuff repair surgery?

Accepted Answer

Yes. Medicare Part B covers arthroscopic rotator cuff repair (CPT 29827) when medically necessary — generally when conservative treatment (physical therapy, injections) has failed. Medicare pays 80% of the approved amount for the surgeon fee, facility fee, and anesthesia. The procedure is almost always performed outpatient in an HOPD or ASC. Inpatient admission is rare and reserved for complex cases or patients with significant comorbidities.

Question 2

Is it cheaper to have rotator cuff surgery at an ASC vs hospital?

Accepted Answer

Yes, significantly. The ASC facility fee for rotator cuff repair is approximately $2,810, versus $4,218 for a hospital outpatient department (HOPD) — a difference of $1,408. Your 20% coinsurance share is $562 at an ASC vs $844 at an HOPD. If your surgeon has privileges at both settings, ask to be scheduled at the ASC. Both are fully covered by Medicare Part B; the only difference is the facility fee rate.

Question 3

What does Medicare pay for rotator cuff surgery (CPT 29827)?

Accepted Answer

In 2026, Medicare's approved surgeon fee for CPT 29827 (arthroscopic rotator cuff repair) is approximately $642 nationally, with regional variation based on Geographic Practice Cost Indices (GPCI). Medicare pays 80% ($514); you owe 20% ($128). The facility fee is separate: $2,810 at an ASC or $4,218 at an HOPD. Anesthesia adds $500–$900. Your total out-of-pocket without Medigap is approximately $1,000–$1,500 in an ASC setting.

Question 4

Why does this calculator show a different amount than Medicare.gov's cost estimate?

Accepted Answer

This calculator may show a higher number than Medicare.gov's "Patient Pays (average)" for several reasons: (1) Deductible timing — this calculator applies the $283 Part B annual deductible if it has not yet been met; Medicare.gov's average assumes many patients have already satisfied theirs. (2) Anesthesia — Medicare.gov's estimate covers the facility fee and surgeon only; anesthesia is billed separately and is included in this calculator. (3) Location adjustment — surgeon fees are adjusted by your region's Geographic Practice Cost Index (GPCI); in high-cost cities like Seattle or New York, surgeon fees run 30–50% above the national rate. Facility fees (HOPD and ASC) are nationally fixed by CMS and should match Medicare.gov exactly. (4) Patient mix — Medicare.gov's "Patient Pays" average includes Medigap enrollees who pay $0 coinsurance, which pulls the reported average below what uninsured Original Medicare patients typically pay.

Cost Component	Medicare-Approved Amount	Your Share (20%)
Surgeon Fee — Rotator Cuff Repair (CPT 29827)	$976	$195
Hospital Outpatient (HOPD) Facility Fee	$7,413	$1,483
Ambulatory Surgery Center (ASC) Facility Fee	$3,695	$739
Inpatient Hospital (DRG 483) — Medicare Pays	$20,170	$1,736 Part A deductible
Anesthesia (estimated)	$500–$900	20% of approved

Medicare Rotator Cuff Repair Cost 2026 | Out-of-Pocket Estimator

2026 Medicare Cost Summary — Rotator Cuff Repair (CPT 29827)

What Medicare Pays

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