The rotator cuff is a group of muscles and tendons holding the shoulder joint in place. If an individual injures their rotator cuff, Medicare may cover the surgery costs if a doctor confirms it is medically necessary.
Out-of-pocket costs may vary depending on:
- a person’s plan type
- where they live
- their plan provider
- the type of facility they use
- the surgical procedure they require
The different parts of Medicare cover items or services differently. It is important for people to check their plan documents or contact Medicare or their plan provider to confirm coverage and avoid unexpected costs.
The table below shows some rotator cuff surgical procedures that Medicare covers, along with the approximate out-of-pocket costs.
The costs derive from Medicare’s 2024 national claim averages for the same procedures.
| Surgery type | Out-of-pocket costs at an ambulatory surgical center | Out-of-pocket costs at a hospital outpatient department |
|---|---|---|
| surgical shoulder arthroscopy with rotator cuff repair | $889 | $1,574 |
| surgical shoulder arthroscopy, debridement, extensive, involving three or more discrete structures, including the articular side of the rotator cuff and the bursal side of the rotator cuff | $421 | $734 |
| surgical shoulder arthroscopy, debridement, limited, involving one or two discrete structures, including the articular side of the rotator cuff and the bursal side of the rotator cuff | $411 | $724 |
| open repair of ruptured musculotendinous cuff (e.g. rotator cuff) — chronic | $847 | $1,532 |
| open repair of ruptured musculotendinous cuff (e.g., rotator cuff) — acute | $840 | $1,525 |
A person can find the cost of a specific surgery by speaking with their surgeon, doctor, healthcare facility, Medicare, or the private insurer administering their plan.
Depending on the circumstances of a person’s rotator cuff surgery, Medicare may cover the costs and associated healthcare services differently. However, the 2025 costs may include:
- Inpatient surgery: If a doctor or healthcare professional requires a person to stay in the hospital to have surgery, Part A will cover eligible costs. Individuals must first pay the Part A deductible of $1,676, which covers the first 60 days of inpatient hospital care in a benefit period. If their stay exceeds 60 days, they need to pay an incremental copayment.
- Copayment: If a person requires a longer hospital stay, they will pay a daily copayment of $419 from day 61 to 90. Days 91 to 150 have a daily copayment of $838 while using lifetime reserve days. Individuals are responsible for all costs for days 151 and beyond.
- Outpatient surgery: For outpatient surgery, a person must first pay the $257 Medicare Part B deductible. After they have paid this amount, they will pay a 20% coinsurance for all eligible services.
- Durable medical equipment (DME): Individuals may need to pay a 20% coinsurance for DME items, such as an arm sling or support.
- Physical therapy: If a person needs physical therapy following their rotator cuff procedure, a 20% coinsurance will typically apply.
- Prescription medications: If an individual receives medications in a hospital or doctor’s office, Part A or B will often cover the costs. However, if they require take-home medications, Medicare Part D prescription drug plans will cover eligible expenses. Private insurers administer these plans, so costs can vary.