Technological advances in outpatient shoulder surgery, particularly in arthroscopy, mean that increasingly complex procedures can be performed on an outpatient basis, which brings benefits for patients and cost savings. In Germany, these services are mainly billed according to the standardised assessment scale (EBM), whereby the complexity of billing, particularly for simultaneous procedures and the consideration of material costs and implants, is emphasised. Due to regional differences in remuneration, point values and billing modalities may vary. Correct documentation is particularly important for billing. In 2023, outpatient treatment was promoted by means of funding incentives to encourage the transition from inpatient to outpatient services. At the same time, remuneration models such as hybrid diagnostic-related groups (DRGs) were introduced as part of the hospital reform, but these led to challenges in terms of cost coverage due to inadequate calculations and unclear calculation bases. Outpatient shoulder arthroscopy is a significant step forward, but the current billing and reimbursement regulations must be improved to ensure sustainable care.