Closed treatment of sternoclavicular joint dislocation with manipulation under anesthesia or sedation, without surgical opening of the joint.

Verified May 8, 2026 · 5 sources ↓

Medicare: $446.24
Total RVUs: 13.36
Global, days: 90
Region: Shoulder

Drawn from CMSCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Direction of dislocation documented (anterior vs. posterior) — posterior dislocations require explicit notation due to mediastinal risk.
Reduction technique described in detail, including patient positioning, applied forces, and any assistance required.
Pre- and post-reduction neurovascular status of the ipsilateral upper extremity recorded.
Imaging confirmation of reduction documented — specify modality (X-ray, fluoroscopy, or CT) and findings.
Type of immobilization applied post-reduction (sling, figure-eight strap, shoulder immobilizer) and duration of immobilization plan.
Any conscious sedation or anesthesia used during manipulation should be noted, as this supports the 'with manipulation' coding distinction over 23524.

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 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 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 23525 covers closed reduction of a sternoclavicular (SC) joint dislocation that requires manipulation — meaning the physician manually repositions the clavicular head relative to the sternum without making a surgical incision. This distinguishes it from 23524, which covers closed treatment without manipulation, and from 23530/23532, which involve open reduction. The 90-day global period applies, so all routine post-reduction management through day 90 is bundled — including immobilization checks, sling/figure-eight strap adjustments, and related office visits.

Documentation must capture the direction of dislocation (anterior vs. posterior), the specific reduction technique used, and the patient's neurovascular status both before and after manipulation. Posterior SC dislocations carry risk of mediastinal injury; if a thoracic or vascular surgery consult is involved on the same day, that service may be separately billable with appropriate modifier support. Imaging performed to confirm reduction is separately reportable — fluoroscopy or CT is commonly used and should be coded independently.

For bilateral SC dislocations (rare but reported in trauma), modifier 50 applies. If the treating physician performs only the manipulation and another provider handles all post-operative management, split global billing applies. Any E&M service on the same day as the procedure requires modifier 25 to be separately payable, and only if it is a significant, separately identifiable service unrelated to the decision to perform the reduction.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	3.7
Practice expense RVU	8.87
Malpractice RVU	0.79
Total RVU	13.36
Medicare national rate	$446.24
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	$446.24
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 23525 get rejected.

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

Code billed as 23525 when documentation does not support manipulation — payers downcode to 23524 if no reduction technique is described.
Same-day E&M billed without modifier 25, resulting in automatic bundling denial.
Imaging billed as included when it is separately reportable — or conversely, imaging separately billed without distinct documentation supporting a separate service.
Global period violations: post-reduction visits billed within 90 days without modifier 24 when the visit is unrelated to the reduction, or without recognizing that routine visits are already bundled.
Laterality not specified when required by payer — some commercial payers require LT or RT on shoulder procedures even for midline-adjacent anatomy like the SC joint.

Frequently asked questions

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

01What is the difference between CPT 23524 and 23525?

23524 is closed treatment of an SC dislocation without manipulation — the joint is managed conservatively with immobilization only. 23525 requires that the physician actively performed a reduction maneuver. If your note doesn't describe the manipulation technique, expect a downcode to 23524.

02Can I bill a same-day E&M with 23525?

Yes, but only with modifier 25 on the E&M, and only if it represents a significant, separately identifiable service unrelated to the decision to perform the reduction. Documenting a new problem or unrelated complaint assessed that day is the standard support. The decision to perform the manipulation alone does not justify a separate E&M.

03Is imaging separately billable when performed to confirm SC joint reduction?

Yes. Radiologic guidance or post-reduction imaging is separately reportable under 23525 because the code descriptor does not include radiologic guidance. Bill the appropriate imaging code (e.g., fluoroscopy or CT) separately with supporting documentation of the independent imaging service.

04Does the 90-day global period apply to 23525?

Yes. The 90-day global covers the surgery, any visit the day before, and all routine post-reduction management through day 90. Visits for unrelated conditions in that window require modifier 24 on the E&M. A new injury or complication requiring a return procedure uses modifier 78 (related) or 79 (unrelated).

05How do I bill if a posterior SC dislocation requires a thoracic surgery consult intraoperatively?

If a thoracic or vascular surgeon assists due to posterior dislocation and mediastinal risk, that surgeon bills with modifier 80 (or AS for a PA/NP assistant). The primary surgeon bills 23525 without a co-surgery modifier unless both surgeons performed distinct, separately defined surgical roles — which is uncommon for a closed manipulation.

06Can 23525 be billed bilaterally?

Bilateral SC dislocations are rare but do occur in high-energy trauma. If both joints are reduced at the same encounter, append modifier 50 and bill as a single line per standard bilateral procedure rules. Document each joint's dislocation direction and reduction technique separately in the operative note.

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 direction of SC joint dislocation (anterior or posterior), the specific manipulation technique used, pre- and post-reduction neurovascular findings, imaging modality confirming reduction, and immobilization type applied. This prevents the most common downcode from 23525 to 23524 — which fires when the operative note omits any description of the actual reduction maneuver.

See how Mira captures CPT 23525 documentation