Closed treatment of a clavicular fracture with manual realignment of bone fragments, no surgical incision required.

Verified May 8, 2026 · 6 sources ↓

Medicare: $408.83
Work RVU: 3.73
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCFindacodeMdclarityCodingintel

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify fracture location on the clavicle (midshaft, medial end, lateral end) and laterality
Document displacement status and the clinical indication for manipulation rather than immobilization alone
Record pre- and post-manipulation alignment findings, including imaging interpretation
Document the type of immobilization applied (sling, figure-of-eight brace, splint) at the time of treatment
Note neurovascular status of the extremity before and after manipulation
Confirm the treating provider performed the manipulation — not just supervised it

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 51 Multiple procedures 52 Reduced services 54 Modifier 58 Staged or related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 23505 covers closed treatment of a clavicle (collarbone) fracture that requires manipulation — meaning the provider physically realigns the displaced bone fragments without making a surgical incision. This distinguishes it from 23500, which is closed treatment without manipulation. The 90-day global period begins on the date of the procedure and covers the pre-op day-of visit, the manipulation itself, and all routine post-fracture care through day 90. Separate billing for fracture follow-up visits, casting, or splinting applied at the time of manipulation is not permitted within that global window unless a distinct unrelated condition is documented.

Fracture care coding fundamentals apply here: the cast or splint applied at the time of manipulation is included in 23505 — you don't separately bill a casting code. If a new cast is applied at a later date due to a problem related to the fracture, that also falls inside the global. Supplies (fiberglass, padding) may be separately reportable depending on payer contract terms. Bilateral clavicle fractures treated in the same session require modifier 50. If the treating physician hands off post-op care to a different provider, split global modifiers 54 and 55 apply.

ICD-10 diagnosis codes should specify laterality and displacement status (displaced vs. nondisplaced) and fracture location (shaft, lateral end, medial end). Payers frequently deny 23505 when the linked diagnosis code describes a nondisplaced fracture — manipulation of a nondisplaced fracture is clinically unusual and will attract scrutiny. Document the clinical rationale clearly when manipulation is performed on a minimally displaced fracture.

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 (3.73) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (12.24) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	3.73
Practice expense RVU	7.7
Malpractice RVU	0.81
Total RVU	12.24
Medicare national rate	$408.83
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	$408.83
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 23505 get rejected.

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

Diagnosis code reflects nondisplaced fracture with no documented rationale for manipulation
Routine follow-up visits billed separately inside the 90-day global without modifier 24
Cast or splinting supply codes billed in addition to 23505 on the same date — bundled into the global
Laterality mismatch between the procedure code modifier (LT/RT) and the ICD-10 diagnosis code
Lack of imaging documentation supporting the fracture diagnosis and post-manipulation alignment

Frequently asked questions

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

01What's the difference between 23500 and 23505?

23500 is closed treatment without manipulation — the bone is immobilized but not actively realigned. 23505 requires the provider to physically manipulate the fragments into better alignment. If you reduced the fracture, bill 23505. If you just applied a sling to a nondisplaced fracture, bill 23500.

02Is the figure-of-eight brace or sling separately billable with 23505?

The immobilization device applied at the time of the manipulation is included in the 23505 global — you can't separately bill a casting or strapping code on the same date. Supplies may be separately reportable depending on your payer contract, but the application service is bundled.

03How do I bill follow-up visits during the 90-day global?

Routine fracture follow-up within the 90-day global is not separately billable. If you see the patient for a condition completely unrelated to the clavicle fracture, append modifier 24 to the E/M and document that the visit addressed a separate problem.

04Can I bill 23505 for a bilateral clavicle fracture?

Yes. Append modifier 50 when both clavicles are treated in the same session. Some payers require LT and RT on separate line items instead — verify payer-specific bilateral billing rules before submitting.

05What if one provider performs the manipulation and a different provider handles all post-op care?

Use split global modifiers: the treating surgeon bills 23505 with modifier 54 (surgical care only), and the follow-up provider bills 23505 with modifier 55 (postoperative management only). Both must document the transfer of care.

06Does a new cast application after a follow-up visit get billed separately?

If the cast is replaced due to a complication or clinical change related to the original fracture within the 90-day global, it's still bundled. Separate casting codes are only billable when clearly unrelated to the original injury or after the global period ends.

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 location and laterality, displacement status, the provider's clinical rationale for manipulation, pre- and post-manipulation alignment findings, imaging interpretation, and the immobilization device applied. That documentation directly addresses the two most common denial triggers for 23505: a nondisplaced-fracture diagnosis paired with a manipulation code, and missing post-reduction alignment confirmation. Audit teams pull these notes first.

See how Mira captures CPT 23505 documentation