Closed treatment of a scapular fracture performed without manipulation of the fracture fragments.

Verified May 8, 2026 · 7 sources ↓

Medicare: $265.87
Total RVUs: 7.96
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCMdclarityNIHFindacode

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Confirm the diagnosis is a scapular fracture with a specific ICD-10 code identifying the fracture site and laterality.
Document that no manipulation was performed — state explicitly that closed treatment without reduction was provided.
Record the immobilization method applied (e.g., sling, shoulder immobilizer) and patient instructions given.
If modifier 22 is appended, the clinical note must describe the specific factors that made the procedure substantially more work than typical.
If a same-day E/M is billed with modifier 25, document the separately identifiable medical decision-making distinct from fracture management.
Laterality must be documented — left or right scapula — to support LT or RT modifier when required by payer.

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 59 Distinct service 76 Repeat, same physician LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 23570 covers non-operative management of a scapular fracture where the treating physician provides closed treatment but does not manually reduce or reposition the fracture fragments. No incision is made and no surgical intervention is performed. The fracture is treated conservatively — typically with immobilization — and the physician's work includes the clinical assessment, application of any immobilizing device, and the management plan.

This code carries a 90-day global period. That window includes the day of service, the day-before preoperative visit if applicable, and all routine fracture-care follow-up through day 90. Separate billing for routine post-fracture visits during the global period is not permitted without modifier 24. If a separate, significant E/M is performed on the same day as the initial fracture treatment, modifier 25 is required.

Scapular fractures are relatively uncommon and often associated with high-energy trauma, meaning concomitant injuries are frequent. When a separately identifiable E/M addressing those other injuries is performed on the same encounter, document it distinctly and append modifier 25. If the procedure required substantially greater work than typical — such as extreme patient complexity or unusual injury pattern — modifier 22 is applicable, but the operative or clinical note must explicitly support that claim.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	2.3
Practice expense RVU	5.19
Malpractice RVU	0.47
Total RVU	7.96
Medicare national rate	$265.87
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	$265.87
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 23570 get rejected.

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

Missing or mismatched laterality between the ICD-10 code and any modifier (LT/RT) required by the payer.
Routine post-fracture follow-up billed during the 90-day global period without modifier 24, triggering global period bundling edits.
Same-day E/M submitted without modifier 25, causing the E/M to be denied as already included in the fracture management.
ICD-10 code specificity insufficient — using an unspecified fracture code when laterality and fracture site are documented in the record.
Modifier 22 submitted without supporting documentation that quantifies or describes the additional work, resulting in automatic denial or downcoding.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What is the global period for CPT 23570?

90 days. All routine fracture follow-up visits, dressing checks, and immobilization adjustments are bundled into that period. Bill separate E/M services during this window only for unrelated conditions, appending modifier 24.

02When does 23570 become 23575 (closed treatment with manipulation)?

If any manual reduction or repositioning of the scapular fracture fragments is performed, the correct code is 23575, not 23570. The distinction is clinical and must be documented explicitly in the note — 'manipulation performed' or 'reduction achieved' are the operative phrases.

03Can you bill a same-day E/M with 23570?

Yes, if the E/M is significant and separately identifiable from the fracture management itself — for example, evaluating associated rib fractures or neurovascular injury. Append modifier 25 to the E/M code and document the separate medical decision-making clearly.

04Is modifier 57 applicable to 23570?

Yes, when the decision to perform the closed treatment is made at the same E/M visit (day of or day before). Because 23570 carries a 90-day global, modifier 57 on the E/M allows it to be paid separately from the global period.

05Should you append LT or RT to 23570?

Many payers require laterality modifiers on shoulder procedures. Check individual payer policy. When required, append LT for left scapula and RT for right. Bilateral scapular fractures are rare; if billing both sides, modifier 50 or separate LT/RT line items apply per payer instructions.

06Can modifier 22 be used with 23570?

Yes, but only when documented circumstances made the procedure substantially more demanding than typical — such as extreme body habitus, severe comorbidities complicating management, or an unusually complex fracture pattern. The clinical note must articulate why the work exceeded the norm; a generic reference to complexity will not support the modifier.

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 absence of manipulation explicitly from dictation — phrasing like 'no reduction performed' or 'treated without manipulation' is flagged and preserved verbatim in the clinical note. It also records laterality, immobilization type, and any separately addressed injuries in real time. This prevents the most common 23570 denial: a clinical note that fails to clearly distinguish closed-without-manipulation treatment from a manipulative reduction, or that omits laterality needed to support LT/RT modifiers.

See how Mira captures CPT 23570 documentation