Closed treatment of an acromioclavicular joint dislocation performed with manual manipulation to restore joint alignment without surgical intervention.

Verified May 8, 2026 · 5 sources ↓

Medicare: $502.02
Total RVUs: 15.03
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCMdclarityAAOS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

AC joint dislocation grade documented (I–VI) using accepted classification system
Explicit statement that manual manipulation was performed to achieve reduction
Post-reduction clinical or radiographic assessment confirming attempted realignment
Anesthesia or sedation type and setting documented if manipulation performed under anesthesia
Laterality (left or right shoulder) clearly stated in the procedure note
Mechanism of injury and pre-procedure neurovascular status documented

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 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 23545 covers closed reduction of an acromioclavicular (AC) joint dislocation where the provider manually repositions the displaced clavicle relative to the acromion. No incision is made. The code applies when manipulation is performed — if the dislocation is treated without manipulation, report 23540 instead. Distinguishing between the two is one of the most common coding errors on this injury.

The 90-day global period means all routine follow-up visits, sling adjustments, and repeat manipulation checks are bundled through day 90. Use modifier 24 for unrelated E/M visits during the global window, and modifier 78 for an unplanned return to treat a related complication. If a separate surgeon handles only postoperative management, split the global with modifiers 54 and 55.

AC dislocations are graded I–VI; closed manipulation is appropriate for select grade III injuries and occasionally grade II when conservative care fails. Operative reports should document the grade, the reduction technique, and the post-reduction assessment — payers increasingly request this detail to distinguish 23545 from the non-manipulation code 23540 and from open procedures in the 23550–23552 range.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	3.34
Practice expense RVU	10.86
Malpractice RVU	0.83
Total RVU	15.03
Medicare national rate	$502.02
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	$502.02
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 23545 get rejected.

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

Code billed as 23545 but documentation supports only treatment without manipulation — should be 23540
Laterality modifier (LT or RT) missing, triggering claim rejection at clearinghouse or payer level
Routine post-reduction follow-up visits billed separately during the 90-day global period without modifier 24
Payer downcodes to 23540 when operative or procedure note does not explicitly describe the manipulation technique
Bilateral modifier 50 applied without payer pre-authorization or documentation of bilateral AC dislocation

Frequently asked questions

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

01What is the difference between CPT 23540 and 23545?

23540 is closed treatment without manipulation — sling immobilization only. 23545 requires that the provider actively performed manual manipulation to reduce the dislocation. Bill based on what was actually done; the note must say manipulation occurred.

02Does 23545 require a laterality modifier?

Yes. Append LT or RT on every claim. Missing laterality is a top clean-claim failure point. If both shoulders are treated in the same session, use modifier 50 and verify bilateral coverage with the payer in advance.

03What is the global period for 23545 and what does it include?

23545 carries a 90-day global. It bundles the day-of and day-before pre-op visit, the procedure, and all routine post-op visits through day 90. Bill unrelated E/M services with modifier 24, and use modifier 78 if the patient returns for a related complication procedure.

04Can 23545 be billed same-day with imaging codes?

Pre- and post-reduction radiographs are commonly obtained but may or may not be separately billable depending on payer policy and who performed the interpretation. Confirm with your payer whether the physician interpretation component (modifier 26) is separately payable alongside 23545.

05When is modifier 22 appropriate with 23545?

Use modifier 22 when the manipulation required substantially greater effort than typical — for example, a severely displaced grade III injury with significant muscular resistance requiring multiple reduction attempts. Documentation must quantify the added complexity; without it, the modifier will be denied.

06Is 23545 appropriate for all AC dislocation grades?

Closed manipulation is generally applied to select grade II and grade III injuries. Grades IV–VI typically require open repair (23550 or 23552). If the operative plan changes from closed to open during the same session, report the open code with modifier 22 if warranted — do not stack 23545 with an open repair code.

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 AC joint dislocation grade, the specific manipulation technique performed, post-reduction assessment findings, laterality, and anesthesia type directly from dictation. This prevents the most common denial on this code: a note that documents a dislocation was treated but omits explicit language confirming manipulation occurred — giving payers a basis to downcode to 23540.

See how Mira captures CPT 23545 documentation