With Original Medicare, rotator cuff surgery typically costs between $934 and $1,677 out of pocket, depending on where you have it done. The total Medicare-approved amount for the procedure ranges from $4,671 to $8,389, but Medicare covers 80% of that, leaving you responsible for the remaining 20%. These are national averages based on Medicare’s 2026 payment rates, and your actual costs can shift based on facility type, supplemental coverage, and your specific plan.
Cost by Facility Type
The single biggest factor in what you’ll pay is whether your surgery happens at an ambulatory surgical center (ASC) or a hospital outpatient department. An ASC is a standalone facility designed for same-day procedures, while a hospital outpatient department is part of a hospital campus. The surgeon’s fee is identical in both settings. The difference comes entirely from the facility fee, which hospitals charge at a much higher rate.
At an ambulatory surgical center, the total Medicare-approved cost is $4,671. Medicare pays $3,737, and your share is $934. At a hospital outpatient department, the total approved cost jumps to $8,389. Medicare pays $6,711, and your share is $1,677. That’s an 80% higher out-of-pocket cost for the same procedure, performed by the same surgeon, simply because of where it takes place.
Research published in the Orthopaedic Journal of Sports Medicine found that shoulder procedures at ASCs cost 42% less overall compared to hospital outpatient departments. Patients paid $400 to $500 more on average when they chose the hospital setting, translating to 30% to 46% higher out-of-pocket expenses. If your surgeon operates at both types of facilities, choosing the ASC can save you several hundred dollars with no difference in the surgical fee itself.
One protective detail worth knowing: Original Medicare caps your copayment for hospital outpatient procedures at $1,676, so even if 20% of the approved amount would technically exceed that, your cost won’t go higher.
What These Numbers Include (and Don’t)
The Medicare-approved amounts listed above cover facility fees and the primary surgeon’s fee. They may not capture every charge. If your surgery requires an assistant surgeon, an anesthesiologist billed separately, or additional procedures done at the same time (such as debriding damaged cartilage or repairing a torn labrum), those generate separate charges with their own 20% coinsurance.
You’ll also need to have met your annual Part B deductible before the 80/20 split kicks in. For 2025, the Part B deductible is $257. If you haven’t met it yet through other medical services that year, that amount gets added to your surgery costs.
Costs Before and After Surgery
The surgery itself isn’t the only expense. Before the procedure, you’ll likely need a shoulder MRI for surgical planning. Under Medicare, the patient share for an MRI averages just $9 to $17 depending on the facility, so that’s a minimal addition.
Physical therapy after rotator cuff repair is where costs accumulate. Recovery typically requires months of supervised rehabilitation. Medicare Part B covers medically necessary outpatient physical therapy with no annual dollar cap, so there’s no limit on how much Medicare will pay as long as your therapist documents that continued treatment is needed. You’ll still owe 20% coinsurance on each therapy session, which generally runs a few dollars to around $30 per visit. Over several months of regular sessions, that adds up.
How Medigap Reduces Your Share
If you carry a Medigap (Medicare Supplement) policy, your out-of-pocket costs drop substantially. Most Medigap plans, including the popular Plan G, cover the 20% coinsurance that Original Medicare leaves behind. With Plan G, your share of the surgery itself would be $0 after you’ve paid the annual Part B deductible. The same applies to your physical therapy coinsurance, meaning months of rehab visits would also be fully covered beyond the deductible.
Plan N works similarly but charges small copayments for certain office visits, so your therapy sessions might carry a modest per-visit cost. Either way, Medigap can turn a $934 to $1,677 surgery bill into little or nothing out of pocket.
Medicare Advantage Plans
If you’re on a Medicare Advantage plan (Part C) rather than Original Medicare, your costs follow a different structure. These plans set their own copayments and coinsurance rates for surgical procedures, and the amounts vary widely by plan. Some charge a flat copay for outpatient surgery, others use a percentage-based coinsurance similar to Original Medicare, and many have annual out-of-pocket maximums that cap your total spending.
Medicare Advantage plans also commonly require prior authorization for surgical procedures, meaning your plan needs to approve the surgery before it’s scheduled. This doesn’t apply to Original Medicare, which has no prior authorization requirement for rotator cuff repair. If you’re on a Medicare Advantage plan, call the number on your member card to get a cost estimate specific to your benefits and to confirm whether authorization is needed.
How to Minimize Your Costs
If you have a choice of surgical setting, ask your orthopedic surgeon whether the procedure can be done at an ambulatory surgical center. Not every patient qualifies, particularly if you have significant health conditions that make a hospital setting safer, but most arthroscopic rotator cuff repairs are well suited to ASCs. Choosing the ASC over the hospital saves roughly $743 in patient costs under Original Medicare.
Confirm that your surgeon and the facility both accept Medicare assignment, meaning they agree to the Medicare-approved amount as full payment. Surgeons who don’t accept assignment can charge up to 15% above the Medicare rate, adding to your bill. For physical therapy, the same rule applies: using a therapist who accepts assignment keeps your per-session costs predictable.
If you’re on Original Medicare without a Medigap policy and facing the full 20% coinsurance, budget for the surgery cost plus three to six months of physical therapy copayments. For most people, the total out-of-pocket cost including rehab falls in the range of $1,500 to $3,000, though a Medigap plan can cut that to nearly zero beyond your $257 annual deductible.