Open repair of a sternoclavicular dislocation, either acute or chronic, using a fascial graft to reconstruct and stabilize the joint; graft harvest is included in the code.

Verified May 8, 2026 · 6 sources ↓

Medicare: $597.21
Work RVU: 8
Global, days: 90
Region: Shoulder

Drawn from AAPCNIHAbosMdclarityCMS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Mechanism of injury and timeline establishing acute vs. chronic dislocation status
Imaging (CT or X-ray) confirming SC joint displacement and direction (anterior vs. posterior)
Operative note specifying that a fascial graft was harvested and used for ligamentous reconstruction
Graft source identified by name and harvest site (e.g., fascia lata, local fascia)
Internal fixation type and placement documented if pins or screws were used
Laterality (left vs. right SC joint) clearly stated in the operative and preoperative notes
ICD-10-CM diagnosis code supported by imaging and clinical findings — use S43.20, S43.21, or S43.22 as appropriate

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 58 Staged or related 59 Distinct service 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 6 cited references ↓

CPT 23532 covers open surgical treatment of a sternoclavicular (SC) joint dislocation — acute or chronic — where the surgeon uses a fascial graft to reconstruct the ligamentous support and restore joint stability. Graft harvest is bundled; you do not separately bill a graft-harvesting code. Internal fixation such as pins or screws may also be placed during the same procedure without changing the code selection.

SC dislocations are rare, typically caused by high-energy trauma (motor vehicle collisions, contact sports), and posterior dislocations carry vascular risk, which drives the complexity of this procedure. The 90-day global period means all routine post-op management through day 90 is included in the single surgical payment. Bill unrelated E/M services within the global window with modifier 24; unrelated procedures need modifier 79.

When the procedure stops short of fascial graft reconstruction — open repair without graft — use 23530 instead. The step-up to 23532 is specifically the addition of the fascial graft. Verify laterality with modifiers LT or RT; bilateral SC repair in a single session is clinically uncommon but would require modifier 50 with payer pre-authorization.

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 (8) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.88) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8
Practice expense RVU	8.18
Malpractice RVU	1.7
Total RVU	17.88
Medicare national rate	$597.21
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	$597.21
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 23532 get rejected.

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

Billing 23532 when no fascial graft was used — defaults to 23530 without graft documentation
Missing or vague graft documentation; operative note says 'stabilization performed' without naming the graft material or harvest site
Laterality modifier absent — many payers require LT or RT on all unilateral shoulder codes
ICD-10 code mismatch; using a fracture or sprain code instead of the SC dislocation-specific S43.2x series
Separate billing for graft harvest procedure already included in 23532

Frequently asked questions

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

01What is the difference between 23530 and 23532?

23530 is open SC dislocation repair without a graft. 23532 adds fascial graft reconstruction and includes the graft harvest. If the operative note doesn't document a fascial graft, bill 23530 — using 23532 without graft documentation is an upcoding risk.

02Is graft harvest billed separately with 23532?

No. The code descriptor explicitly includes obtaining the graft. Do not separately bill a graft harvest code alongside 23532.

03Which ICD-10 codes pair with 23532?

Use the S43.2x series: S43.20 (unspecified subluxation/dislocation of SC joint), S43.21 (anterior), or S43.22 (posterior). Posterior dislocations are clinically urgent and well-supported by these codes. Always confirm with individual payers for any LCD or coverage policy.

04Does the 90-day global period affect post-op billing?

Yes. Routine post-op visits, wound checks, and dressing changes through day 90 are included in the global payment. Bill modifier 24 for unrelated E/M services and modifier 79 for unrelated procedures performed during that window.

05When is modifier 22 appropriate with 23532?

Use modifier 22 when the procedure required substantially more work than typical — for example, a posterior SC dislocation with vascular involvement requiring additional dissection, or a chronic dislocation with significant scarring. Attach a cover letter quantifying the additional time and complexity; payers will not upgrade payment on modifier 22 without it.

06Can 23532 and 23530 be billed together on the same date?

No. They are mutually exclusive codes describing the same procedure with and without graft. Bill whichever reflects what was actually performed. Billing both on the same date for the same joint will be denied or flagged as duplicate billing.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the dislocation laterality, graft type and harvest site, fixation hardware used, and whether the presentation is acute or chronic — all from dictation. That prevents the most common denial for 23532: an operative note that confirms open repair but lacks explicit documentation of fascial graft harvest, causing payers to downcode the claim to 23530.

See how Mira captures CPT 23532 documentation