Closed treatment of a sternoclavicular joint dislocation performed without any manipulation of the displaced bones.

Verified May 8, 2026 · 8 sources ↓

Medicare: $270.55
Total RVUs: 8.1
Global, days: 90
Region: Shoulder

Drawn from AAPCMdclarityGomedicalbillingEmednySgo

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Mechanism of injury documented (e.g., MVA, contact sports, fall) to support medical necessity
Direction of dislocation specified — anterior or posterior — to align with ICD-10 diagnosis code selection (S43.21 vs. S43.22)
Treatment method described explicitly (sling, immobilizer, figure-of-8 brace) confirming no manipulation was performed
Clinical findings supporting closed non-manipulative approach, including neurovascular status assessment
Imaging (X-ray or CT) referenced to confirm SC dislocation diagnosis and rule out associated injuries
Follow-up plan documented within the 90-day global period to support bundled post-op care expectations

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 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 23520 covers closed, non-manipulative management of a sternoclavicular (SC) joint dislocation — the joint where the clavicle meets the sternum. Treatment consists of immobilization, sling application, or similar conservative measures to allow the joint to heal without physically reducing the displacement. No surgical incision and no manual repositioning of the bones is performed. If manipulation is required, bill 23525 instead; open treatment codes are 23530 and 23532.

SC dislocations are rare but potentially serious injuries, typically resulting from high-impact trauma such as motor vehicle accidents or contact sports. Anterior and posterior displacement are coded differently at the ICD-10 level (S43.21 vs. S43.22), so the diagnosis must specify direction when the operative or encounter note documents it. Code S43.20 covers unspecified displacement.

The 90-day global period bundles all routine post-op E/M visits and related services through day 90. Bill modifier 24 on unrelated E/M services within that window, modifier 78 for an unplanned return to the procedure room for a related issue, and modifier 79 for an unrelated procedure during the global period. NCCI edits apply to 10+ code pairs; CARC 97 denials are common when bundled codes are billed alongside 23520 without appropriate modifier support and documentation.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	2.23
Practice expense RVU	5.4
Malpractice RVU	0.47
Total RVU	8.1
Medicare national rate	$270.55
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	$270.55
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 23520 get rejected.

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

Wrong code selected — 23525 (with manipulation) billed when documentation supports only 23520 (without manipulation), or vice versa
ICD-10 mismatch — unspecified S43.20 used when operative note clearly documents anterior or posterior displacement
CARC 97 denial from billing a bundled code alongside 23520 without modifier 59 or appropriate X-modifier and supporting documentation
E/M visit during the 90-day global period denied for missing modifier 24 when the visit was unrelated to the SC dislocation
Insufficient documentation of treatment method — note says 'conservative management' without specifying the immobilization technique used

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01What is the difference between CPT 23520 and 23525?

23520 is closed treatment without manipulation — the joint is immobilized and allowed to heal naturally. 23525 is closed treatment with manipulation, meaning the physician physically reduces the displacement. The operative or encounter note must clearly state whether manipulation was performed; auditors will flag the record if the documentation is ambiguous.

02Which ICD-10 codes pair with CPT 23520?

The primary ICD-10 options are S43.20 (unspecified SC subluxation/dislocation), S43.21 (anterior), and S43.22 (posterior). Use the direction-specific code whenever the note documents it — payers and audit teams flag S43.20 when the record clearly describes anterior or posterior displacement.

03Does CPT 23520 have a global period, and what does that mean for follow-up visits?

Yes — 23520 carries a 90-day global period. All routine post-op E/M visits related to the SC dislocation are bundled and not separately billable. Use modifier 24 on any E/M visit during that window that is unrelated to the dislocation, with documentation supporting the distinct condition being addressed.

04When should modifier 59 or XS be appended to claims with 23520?

Apply modifier 59 — or preferably XS for a distinct structure — when a second procedure is billed on the same date and an NCCI edit pairs it with 23520 under indicator 1. Indicator 0 pairs cannot be unbundled regardless of modifier. The operative note must document the anatomically distinct service before you append any modifier.

05Can 23520 be billed with a same-day E/M visit?

Yes, with modifier 25 on the E/M code. The E/M must be a significant, separately identifiable service beyond the decision to perform the procedure — for example, a trauma evaluation that addresses injuries beyond the SC joint. Document the distinct medical decision-making in the note.

06Is modifier 22 ever appropriate for 23520?

Rarely, but yes. If the clinical complexity was substantially greater than typical — for example, a posterior dislocation with vascular compromise requiring significantly extended evaluation and management — append modifier 22 with a concise cover letter explaining how the work differed from the standard encounter. Payers require strong documentation; routine cases do not qualify.

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 mechanism of injury, dislocation direction (anterior vs. posterior), treatment method (sling type, immobilizer), confirmation that no manipulation was performed, neurovascular findings, and imaging referenced. This prevents the two most common denials on 23520: ICD-10 mismatch from an unspecified diagnosis code and downcoding or upcoding between 23520 and 23525 when the note is ambiguous about whether manipulation occurred.

See how Mira captures CPT 23520 documentation