Key takeaways:
- Both surgeries are billed under the same procedure code, so your insurer usually pays the surgeon the same amount for either one.
- The hospital’s cost is higher for a reverse replacement: about $25,225 against $21,520 over the first year in a study of more than 86,000 patients.
- For arthritis with a healthy rotator cuff, recent evidence finds outcomes broadly similar, with better range of motion after an anatomic replacement.
- If you run a shoulder or orthopedic practice, I also cover what these numbers mean for the questions your patients are already asking.
When I reviewed the pages that rank for this question, the top results quoted cost figures from 2007 and 2011, and none put the two surgeries side by side. This page does, with the current studies.
The cost difference at a glance
| Reverse | Anatomic | |
|---|---|---|
| Procedure code | CPT 23472 | CPT 23472 |
| Mean 1-year hospital cost | $25,225 | $21,520 |
| Revision or device removal within a year | 2.1% | 1.9% |
| Shoulder-related complications within a year | 12.4% | 9.9% |
| Mean patient age in the study | 71.5 | 66.8 |
Source: a study of 51,478 reverse and 34,623 anatomic total shoulder patients in the Premier hospital database. (Journal of Shoulder and Elbow Surgery, 2024)
Two things stand out. The reverse costs the hospital more, and reverse patients were about five years older on average, which explains part of the difference in complications.
What each surgery is, and who gets it
An anatomic replacement copies the shoulder’s natural shape: a ball on the arm bone and a socket on the shoulder blade. It depends on a working rotator cuff.
A reverse replacement swaps them, putting the ball on the shoulder blade and the socket on the arm. That lets the deltoid muscle do the lifting, so it works even when the rotator cuff is torn beyond repair. It is also common after complex fractures and failed earlier replacements.
The reverse has become the more common operation. Between 2012 and 2017, reverse shoulder replacements in the US rose from 22,835 to 62,705 a year, while anatomic replacements went from 29,685 to 40,665. (Journal of Shoulder and Elbow Surgery, 2020)
If your surgeon recommends a reverse because your rotator cuff is gone, cost is not really the deciding factor. If your cuff is healthy and both are on the table, the comparison below matters more.
What you will actually pay
If you are insured. Both procedures are billed as CPT 23472, the code for a total shoulder replacement. There is no separate code for the reverse design, so the surgeon’s fee from your insurer is usually the same either way. Your share depends on your deductible, your coinsurance and where the surgery happens.
Where it happens matters. Since January 1, 2024, Medicare has allowed total shoulder replacement in ambulatory surgery centers, after CMS added code 23472 to the surgery center covered procedures list. (Ambulatory Surgery Center Association, 2023) A surgery center is usually cheaper than a hospital, for you and for your insurer.
If you are paying cash. Ask for a written total that names the implant. As the table above shows, the reverse carries a higher hospital cost. For the wider picture of what a shoulder replacement costs and what gets billed separately, see my page on shoulder replacement cost.
Why a reverse usually costs more
The study does not split the difference by line item. What it does show is that reverse patients were older, and had higher rates of revisits and complications over the first year, both of which add cost.
The cost of things going wrong is large for both. Revision procedures and device removals averaged $22,920 per procedure after a reverse and $26,911 after an anatomic replacement. When a revision involved an infection, total hospital costs averaged $60,887 for reverse and $59,478 for anatomic patients. (Journal of Shoulder and Elbow Surgery, 2024)
That is the real lesson on price: the cheapest shoulder replacement is the one that does not need a second operation. Surgeon experience matters more to your total cost than the implant design.
Outcomes: does the more expensive option work better?
For arthritis with an intact rotator cuff, a 2026 review of 18 studies found the two surgeries give comparable results for pain and function scores. The anatomic replacement gave better range of motion, and there was no difference in overall complication or revision rates. (Bone & Joint Open, 2026)
So if you are a candidate for both, a reverse is not automatically the better choice just because it is more common or more expensive. Ask your surgeon why they recommend one over the other for your shoulder specifically.
Questions to ask before you choose
- Is my rotator cuff intact? If not, the reverse is usually the only option that works.
- How many shoulder replacements do you do a year, and of which type?
- Can this be done at a surgery center? It often lowers the bill.
- What does the written estimate include? Surgeon, facility, anesthesia, implant, imaging and physical therapy are often billed separately.
- What happens if I need a revision? Ask how often it happens in the surgeon’s own patients.
If you are still weighing surgery against other options, my pages on rotator cuff surgery cost and shoulder arthroscopy cost cover the steps that often come first.
What this means if you run a shoulder or orthopedic practice
A few numbers worth sitting with.
Total shoulder replacement grew 212% in the US between 2012 and 2022, from 55,245 to 172,559 procedures a year, while hip and knee replacement grew 45% and 25% over the same period. The authors project 334,000 to 905,000 shoulder replacements a year by 2035. (Journal of Shoulder and Elbow Surgery, 2026)
Since 2024, those cases can move to surgery centers, where the practice has more control over the patient experience and more reason to fill the schedule directly.
And the patients researching the choice online are finding pages that quote prices from 2007, and none that explain reverse against anatomic in plain terms.
Put those three together however makes sense for your practice. The patient who is choosing a shoulder surgeon today reads before they call, and right now very few shoulder practices are the ones answering the question they typed.
If you want to see what your own shoulder pages and search visibility look like from the patient’s side, book a 20-minute call. I will look at your site and your market before we talk. You can also read what a page like this is worth to an orthopedic practice.
Frequently asked questions
Does Medicare pay more for a reverse shoulder replacement? No. Both are billed as CPT 23472, so Medicare pays the surgeon the same amount. Hospital costs are higher for a reverse, and the patients who need one tend to be older, with more complications in the first year.
Is a reverse shoulder replacement more expensive? For the hospital, yes. One large study found an average 1-year hospital cost of $25,225 for reverse against $21,520 for anatomic.
Can I have a total shoulder replacement at an outpatient surgery center? Yes, for suitable patients. Medicare has covered total shoulder replacement in surgery centers since January 1, 2024.
Which lasts longer, reverse or anatomic? One-year revision rates are similar, about 2% for both in a large study. Longer-term comparisons are still being published.
Why would a surgeon recommend a reverse instead of an anatomic replacement? Most often because the rotator cuff is torn beyond repair. A reverse replacement lets the deltoid muscle lift the arm instead.
