This is a patient demand report for shoulder and orthopedic practice owners and marketing leads. It shows what patients pay for a reverse or an anatomic shoulder replacement, how both are billed, what the evidence patients read says, and what they find when they search before they call. The practice-side facts come first; the patient detail below is the evidence behind them.
For practice owners: what this search looks like from your side
Some facts, side by side.
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 January 1, 2024, Medicare has allowed total shoulder replacement in ambulatory surgery centers. (Ambulatory Surgery Center Association, 2023)
Both designs are billed under the same code, CPT 23472, so the surgeon’s fee from the insurer is usually the same either way.
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.
What those mean together for your practice is for you to work out.
If you want to see what your own shoulder pages and search visibility look like from the patient’s side, book a 30-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.
What patients pay
The hospital’s cost is higher for a reverse: about $25,225 against $21,520 over the first year in a study of more than 86,000 patients.
| 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.
Insured patients. An insured patient’s share depends on their deductible, their coinsurance and where the surgery happens. The implant design does not change the surgeon’s code.
Setting. A surgery center is usually cheaper than a hospital, for the patient and for the insurer.
Self-pay patients. The reverse carries a higher hospital cost, so a cash quote that does not name the implant is hard to compare. For the wider picture of what a shoulder replacement costs and what gets billed separately, see my page on shoulder replacement cost.
When things go wrong. The cost of a second operation 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.
What Medicare pays your practice
Both procedures are billed as CPT 23472, the code for a total shoulder replacement. There is no separate code for the reverse design, so Medicare pays the surgeon the same amount for either one. For 2026 that national facility fee is $1,300.30 under the CMS Physician Fee Schedule (October release), before geographic adjustment.
Since January 1, 2024, CMS has included code 23472 on the surgery center covered procedures list, which means Medicare pays for total shoulder replacement in ambulatory surgery centers as well as hospitals. (Ambulatory Surgery Center Association, 2023)
The difference shows up on the facility side. Hospital costs are higher for a reverse, and the patients who need one tend to be older, with more complications in the first year. For the patient, the share they owe still depends on their deductible, their coinsurance and the setting.
What the evidence patients read says
Why a reverse usually costs more
The 2024 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.
Outcomes for arthritis with an intact rotator cuff
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 for a patient who is a candidate for both, the evidence does not make a reverse the better choice just because it is more common or more expensive.
How long each lasts
One-year revision rates are similar, about 2% for both in the large hospital database study. Longer-term comparisons are still being published.
Who patients are
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)
The two groups differ in age too: 71.5 on average for reverse patients and 66.8 for anatomic patients in the 2024 study.
For a patient whose rotator cuff is torn beyond repair, cost is not really the deciding factor. For a patient with a healthy cuff and both options on the table, the cost and outcome comparison matters more.
For patients still weighing surgery against other options, my pages on rotator cuff surgery cost and shoulder arthroscopy cost cover the steps that often come first.
Questions patients ask before they book
These are the questions your page and your front desk need to answer.
- Is the rotator cuff intact? A good page explains why a reverse is used when the cuff is torn beyond repair, the case the evidence above describes.
- How many shoulder replacements does the surgeon do a year, and of which type? A good page shows volume split by reverse and anatomic.
- Can this be done at a surgery center? A good page says which patients qualify and that it often lowers the bill.
- What does the written estimate include? A good page lists surgeon, facility, anesthesia, implant, imaging and physical therapy, which are often billed separately.
- What happens if a revision is needed? A good page states how often it happens in the surgeon’s own patients.
What a page that wins this search includes
- Reverse and anatomic side by side, with current studies. The pages that rank today quote figures from 2007 and 2011. A table like the one above, with linked sources, is the gap.
- The same-code explanation. Both bill as 23472, so a patient’s plan pays the surgeon the same either way. Saying that early removes a question the front desk otherwise fields.
- Why the surgeon chooses one design over the other. Rotator cuff status, age and prior surgery, explained in plain terms.
- Your volume and revision record by type. Revision cost is where the price gap between surgeons shows up.
- The surgery center option, if you offer it. Since 2024 it is a real choice for suitable Medicare patients.
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 a total shoulder replacement be done 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.
