This page is for owners, administrators and marketing leads at orthopedic and sports medicine practices. It covers what Medicare pays the surgeon in 2026 for an arthroscopic rotator cuff repair, the payment rule that applies when it is done alongside other arthroscopic work, and how the payment changes by locality.
The figures are computed from the CMS 2026 physician fee schedule relative value file (October release) and the 2026 geographic index table in the same download, using the facility formula CMS prints in the file’s readme.
I run a marketing agency for surgical practices. Rotator cuff repair is a high-volume shoulder procedure, and it is often one of the first service lines a sports medicine group wants to promote, so its case value is worth knowing before any spend is planned.
When I reviewed the pages that rank for this procedure’s 2026 Medicare reimbursement, they were billing software, RVU look-up and coding reference pages, plus a CMS coding policy manual from 2025. The results I read gave the national payment and RVUs. None showed what the payment is in a given locality, and none explained how the arthroscopy family rule affects the case value.
The national payment for 2026
The procedure has 29.23 total RVUs in the facility setting. At the 2026 conversion factor of $33.4009, the national surgeon payment is $976.31.
| Component | RVUs | Dollars | Share |
|---|---|---|---|
| Physician work | 15.20 | $507.69 | 52.0% |
| Practice expense (facility) | 10.98 | $366.74 | 37.6% |
| Malpractice | 3.05 | $101.87 | 10.4% |
| Total | 29.23 | $976.31 | 100% |
Practice expense is a bigger share of this fee than it is for the joint replacements, where it sits at about 33%. Physician work is a smaller share.
Clinicians who qualify through an advanced alternative payment model are paid from a version of the file with a $33.5675 conversion factor. For this procedure, that is $981.18, or $4.87 more.
The file lists the procedure as facility only, so there is no office rate.
How it compares with a total shoulder
A total shoulder replacement pays the surgeon $1,300.30 nationally in 2026. The arthroscopic cuff repair pays $976.31, which is $323.99 less, or about 75% of the replacement fee.
Both carry the same 90-day global period, so the post-op care included in the fee covers the same length of time.
The payment in 10 localities
Medicare applies a separate geographic index to the work, practice expense and malpractice parts of the fee in each of its 109 localities. In 2026 the work index has a floor of 1.0, which Congress extended through January 1, 2027.
| Medicare locality | 2026 rotator cuff repair surgeon payment |
|---|---|
| Arkansas (lowest) | $875.19 |
| Alabama | $886.25 |
| Rest of Texas | $947.72 |
| National | $976.31 |
| Houston | $1,016.11 |
| Los Angeles and Orange County | $1,030.01 |
| Suburban Chicago | $1,068.41 |
| Chicago | $1,113.62 |
| Manhattan | $1,127.91 |
| San Jose area (Santa Clara County) | $1,132.83 |
| Miami | $1,147.11 |
| NYC suburbs and Long Island (highest outside Alaska) | $1,165.42 |
| Alaska (work index floor of 1.5) | $1,208.25 |
From Arkansas to Long Island, the same repair differs by $290.23, or 33.2%. In 58 of the 109 localities, the surgeon is paid less than the national figure.
These are fee schedule amounts. Deductibles, coinsurance and adjustments outside this file change what is collected; your remittance data is the final word.
The arthroscopy family rule
This is the detail most practices underestimate. In the CMS file, the procedure’s multiple procedure indicator is 3, not the standard 2 used for the joint replacements. The readme defines indicator 3 this way: “Special rules for multiple endoscopic procedures apply if procedure is billed with another endoscopy in the same family.” The file names a diagnostic shoulder arthroscopy as the base procedure of that family.
In plain terms, when the repair is billed with other arthroscopic shoulder work in the same family, CMS applies its endoscopy rules within the family first, then ranks the family against any other procedures done the same day. The readme also says that if an endoscopic procedure is reported with only its base procedure, the base procedure is not paid separately.
For a practice, that means the payment for a cuff case with added arthroscopic work is not simply the sum of the separate fees. How each combination pays is a question for your coding team.
Other indicators on the same row
- Bilateral: the 150% adjustment applies. Both shoulders on the same day are paid at the lower of the actual charge or $1,464.46 at the national rate.
- Assistant at surgery: may be paid.
- Co-surgeons: could be paid, with documentation of medical necessity.
- Team surgery: not permitted.
The 90-day global package
The CMS file defines a 90-day global as major surgery with a one-day preoperative period and a 90-day postoperative period included in the fee schedule amount.
| Part of the global package | Share | National dollars |
|---|---|---|
| Preoperative | 10% | $97.63 |
| Intraoperative, including in-hospital post-op work | 69% | $673.65 |
| Postoperative office care after discharge | 21% | $205.02 |
Where the facility payment fits
The hospital outpatient department or surgery center is paid separately for the same case, under rates published in CMS addenda that carry an AMA license agreement. I have not used those tables here.
The 2026 rule that sets those facility payments also changes where Medicare surgery can happen. In the Federal Register, CMS wrote that for 2026 it is “phasing out the IPO list over 3 years,” starting with 285 mostly musculoskeletal services, and that it is adding 276 procedures to the surgery center covered procedures list under revised criteria (Federal Register, CMS-1834-FC). Whether a given shoulder procedure is on either list for your site is a question for your coding team and the published addenda.
The facts side by side
The 2026 national Medicare surgeon payment for an arthroscopic rotator cuff repair is $976.31.
A total shoulder replacement pays $1,300.30.
The repair pays $875.19 in Arkansas and $1,165.42 on Long Island.
When it is billed with other arthroscopic work in the same family, CMS applies its endoscopy rules first.
In one orthopedic practice I audited, 92% of Google Ads spend went to a campaign that had produced zero appointments, and the appointment buttons led to a page with no form.
What those mean together for your practice is for you to work out.
If you want a second view on what a shoulder patient costs you to win, book a 30-minute call. I will look at your site and your market before we talk.
Related pages
What patients see on price is on rotator cuff surgery cost and shoulder replacement cost. For the marketing math, see orthopedic patient acquisition cost and Google Ads for orthopedic surgeons cost.
Method
I took the procedure’s work, facility practice expense and malpractice RVUs from the CMS 2026 national relative value file, October release, and the three geographic indices for all 109 localities from Addendum E in the same download. Each locality payment is each RVU times its index, summed, times $33.4009, as set out in the CMS readme. With all indices at 1.0 the result equals the national amount. The CMS physician fee schedule look-up tool returns the same figures for any locality.
Frequently asked questions
How much does Medicare pay for arthroscopic rotator cuff repair in 2026? The national surgeon payment is $976.31 in the facility setting, from 29.23 RVUs at $33.4009. At the alternative payment model conversion factor of $33.5675, it is $981.18.
Why does rotator cuff repair pay differently when other arthroscopic work is done? The procedure carries the multiple endoscopy indicator in the CMS file. When billed with another arthroscopy in the same family, CMS applies its endoscopy rules to that family before ranking it against other procedures.
How much does the payment vary by location? In the lower 48 it ranges from $875.19 in Arkansas to $1,165.42 on Long Island. Alaska is $1,208.25.
Are post-op visits included in the fee? Yes. Routine care in the 90-day global period is included.
Does this page include the hospital or surgery center payment? No. It covers only the surgeon’s payment under the physician fee schedule.
