Open surgical repair of a broken clavicle with internal fixation devices such as plates, screws, or pins to stabilize the fracture.

Verified May 8, 2026 · 5 sources ↓

Medicare: $679.04
Total RVUs: 20.33
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCJnjmedtechDrmillettEmedny

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Fracture displacement and pattern (displaced, nondisplaced, comminuted, midshaft vs. medial/lateral) documented in the preoperative assessment or imaging interpretation
Operative note must name the specific fixation hardware used (plate type, screw configuration, or pin placement) — notes that only say 'internal fixation performed' are audit targets
Laterality explicitly documented in the operative report and on the claim (LT or RT modifier)
Indication for open treatment over closed management — conservative failure, displacement threshold, patient factors — documented in the pre-op note
If modifier 22 is appended, the operative note must specifically describe the complexity encountered (e.g., severe comminution, extensive soft-tissue stripping, intraoperative implant exchange) and estimate additional time or difficulty

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 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 23515 covers open treatment of a clavicular fracture, including internal fixation when performed. The surgeon makes a direct incision over the clavicle, reduces the fracture, and secures it with hardware — most commonly a plate and screws on the anterosuperior surface, though pins or intramedullary devices may also be used depending on fracture pattern and bone quality. The code bundles the fixation work; internal fixation is not separately billable.

This is a 90-day global procedure. All routine post-op care — wound checks, dressing changes, hardware monitoring visits — is included through day 90. An E/M billed during that window for an unrelated condition requires modifier 24. A new injury or unrelated procedure during the global needs modifier 79.

Laterality matters for claim submission. Use modifier LT or RT to identify the operative side. Bilateral clavicle ORIF in one session is exceedingly rare but would use modifier 50. If the procedure required substantially more work than typical — severe comminution, prior hardware removal, nonunion takedown — modifier 22 applies, and the operative note must quantify why the work exceeded the standard.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.45
Practice expense RVU	8.94
Malpractice RVU	1.94
Total RVU	20.33
Medicare national rate	$679.04
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	$679.04
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,818.52

Common denial reasons

The recurring reasons claims for CPT 23515 get rejected.

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

Missing laterality modifier (LT/RT) causing claim rejection or payer-specific edit failure
Modifier 22 appended without operative note language that quantifies the increased complexity — payers require more than a generic 'difficult case' statement
E/M billed within the 90-day global without modifier 24, flagged as bundled service
ICD-10-CM diagnosis code laterality mismatch with the LT/RT modifier on the claim
Nonunion or malunion cases coded as 23515 without supporting documentation that the original fracture site was addressed as a fresh fracture — nonunion ORIF coding is a separate, frequently audited issue

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Does 23515 include the cost of the plate and screws?

The physician fee under 23515 bundles the surgical work, not the implant cost. Facility implant costs are captured on the facility claim through separate HCPCS implant codes or cost reporting — not on the physician claim.

02Can I bill 23515 for a nonunion takedown with re-plating?

Not straightforwardly. If the nonunion requires hardware removal plus re-fixation of a true nonunion, 23515 alone undercodes the work. Many coders add an unlisted code (23929) for the nonunion takedown component. Document each distinct surgical step and submit with a cover letter to the payer explaining the additional work.

03What ICD-10-CM codes pair with 23515?

Most commonly S42.021A–S42.026A for initial encounter displaced and nondisplaced shaft fractures. Use the 'A' suffix for the initial surgical encounter, 'D' for subsequent routine healing encounters. Confirm left/right laterality matches the LT/RT modifier on the claim.

04Can 23515 and 23570 (closed scapular fracture) be billed together in the same session?

Yes, but expect a multiple-procedure reduction. Append modifier 51 to the lower-valued code. Check NCCI edits before submitting — payers may bundle them or require documentation showing each fracture was separately addressed.

05What is the global period for 23515 and what does it cover?

90-day global. It includes the day-before preoperative visit, the surgery itself, and all routine post-op care through day 90. Bill E/M services within the global only if they address an unrelated condition (modifier 24) or a new problem requiring a separately documented decision for surgery (modifier 25 or 57).

06When is modifier 22 justified for 23515?

Modifier 22 is warranted when the operative work substantially exceeds typical clavicle ORIF — severe comminution requiring extended fixation, prior implant removal before re-fixation, or significantly prolonged operative time. The operative note must describe the specific factors; 'difficult anatomy' alone won't hold up to audit. Submit with a brief cover letter and expect a manual review.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the fracture pattern and location (midshaft, medial, lateral third), displacement status, specific hardware used (plate manufacturer, screw count and size), operative approach, and reduction technique from dictation. It also flags laterality for modifier assignment and pulls complexity language verbatim if the surgeon dictates factors that would support modifier 22. This prevents the two most common denials for 23515: missing or mismatched laterality and unsupported modifier 22 claims.

See how Mira captures CPT 23515 documentation