Closed treatment of a clavicular (collarbone) fracture requiring no bone manipulation or surgical intervention — typically managed with sling immobilization and clinical monitoring.

Verified May 8, 2026 · 6 sources ↓

Medicare: $258.19
Work RVU: 2.15
Global, days: 90
Region: Shoulder

Drawn from CMSGoAAPCCgsmedicare

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Confirmed fracture diagnosis with imaging reference (X-ray or CT) and fracture pattern description
Clinical decision-making documenting why manipulation was not required (e.g., nondisplaced, minimal angulation)
Type of immobilization applied or recommended, or explicit notation if no device was used and rationale
Date definitive fracture care was assumed — critical when transferring care from ED to orthopedic practice
Follow-up plan with anticipated duration of immobilization and return-to-activity criteria
For modifier 22: specific documentation of complexity beyond typical — time, difficulty, or complicating factors must be explicit in the note

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 50 Bilateral procedure 52 Reduced services LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 23500 covers the closed, non-manipulative treatment of a clavicle fracture. The treating provider confirms the fracture diagnosis, determines that realignment is not required, and initiates an immobilization plan — most often a sling or figure-of-eight bandage. No cast, splint, or surgical reduction is necessary to bill this code. Per AAOS guidance, the absence of an applied device on the initial visit does not disqualify the code.

The 90-day global period begins on the date of the definitive fracture care visit — not the ER visit, if a different provider assumes care. That global includes all routine follow-up E/M services, clinical checks, and device adjustments through day 90. An E/M billed same-day at the initial fracture care encounter requires modifier 25. E/M visits within the global for unrelated conditions require modifier 24. If the orthopedist takes over care from an ED provider who billed separately, the transfer-of-care modifiers 54 and 55 apply to split the global appropriately.

Bilateral clavicle fractures are uncommon but do occur — report with modifier 50 and confirm the operative note documents both sides. Modifier 22 is appropriate when documented complexity substantially exceeds the typical encounter, such as a polytrauma setting requiring extended assessment and coordination. Imaging obtained at the same encounter is separately billable and not bundled into 23500.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (2.15) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (7.73) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.15
Practice expense RVU	5.13
Malpractice RVU	0.45
Total RVU	7.73
Medicare national rate	$258.19
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$258.19
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI A2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 23500 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Same-day E/M billed without modifier 25, triggering NCCI bundling denial
Global period overlap when a second provider bills 23500 after the ED already billed fracture care for the same episode without modifier 55
Missing or vague clinical rationale for non-manipulation — payers audit for documentation that a treatment decision was actually made
Bilateral billing (modifier 50) rejected when only one side is documented in the operative or clinical note
ICD-10 laterality mismatch between the diagnosis code and the LT/RT modifier on the claim

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Can we bill 23500 if no sling or splint was applied at the visit?

Yes. Per AAOS guidance, the global fracture code 23500 is billable even when no immobilization device is applied on the initial date. The code covers the work of diagnosis and care planning, not just device application. Document the clinical rationale for the management approach.

02The ER physician saw the fracture first. Can the orthopedist bill 23500 when the patient follows up?

Only if the ER did not bill 23500 or another fracture care code. If the ER billed an E/M only, the orthopedist bills 23500 for assuming definitive care. If fracture care was already billed in the ED, use modifier 54 (surgical care only) or 55 (post-op management only) to split the global and avoid duplicate billing.

03What modifier is needed to bill an E/M on the same day as 23500?

Modifier 25 on the E/M. The note must support a significant, separately identifiable evaluation beyond what is inherent to the fracture care visit — for example, assessing a concurrent shoulder injury or comorbidity management.

04How long does the 90-day global run, and what does it include?

The global starts on the date of the fracture care service and runs through day 90. It covers all routine follow-up E/M visits related to the clavicle fracture, device checks, and standard clinical monitoring. Anything unrelated to the fracture requires modifier 24 to bill separately within that window.

05When is modifier 22 appropriate for 23500?

When the clinical work is substantially greater than a routine nondisplaced clavicle fracture — for example, a polytrauma patient requiring extended assessment, or a fracture with neurovascular compromise requiring prolonged evaluation. The note must explicitly document the added complexity; a brief note with a modifier 22 appended will not withstand audit.

06Is imaging separately billable on the same date as 23500?

Yes. Radiographic interpretation is not bundled into 23500. Bill the appropriate radiology code separately. If the facility owns the equipment, bill with modifier 26 for the professional component only when applicable.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the fracture pattern (displaced vs. nondisplaced), the clinical rationale for forgoing manipulation, the immobilization device used or explicitly not used, and the date the orthopedist assumed definitive care. That detail prevents the two most common 23500 denials: missing decision-making documentation and global period overlap when taking over from an ED provider.

See how Mira captures CPT 23500 documentation