Closed treatment of a scapular fracture with manipulation, with or without skeletal traction, with or without shoulder joint involvement

Verified May 8, 2026 · 7 sources ↓

Medicare: $458.93
Work RVU: 4.12
Global, days: 90
Region: Shoulder

Drawn from CMSFastrvuMdclarityGenhealthEmedny

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Pre-treatment imaging (X-ray or CT) confirming scapular fracture with displacement or angulation requiring manipulation
Explicit documentation that closed manipulation was performed — note technique, force applied, and post-reduction position
Record whether skeletal traction was applied, including setup and duration if used
Document glenohumeral or acromioclavicular joint involvement, or explicitly note absence
Post-reduction imaging confirming fracture alignment after manipulation
Anesthesia type used (local, regional, sedation, or general) to support facility and anesthesia billing
Mechanism of injury and associated injuries, particularly rib fractures, pneumothorax, or neurovascular compromise

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 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 23575 covers closed (non-surgical) realignment of a fractured scapula where the treating physician manually reduces the fracture and may apply skeletal traction to achieve proper bone alignment. No incision is made. The code applies whether or not the shoulder joint is involved in the fracture pattern, and whether or not traction is ultimately used — the key distinguishing factor from 23570 is that manipulation is performed.

This code carries a 90-day global period. That window covers the procedure itself, the day-before preoperative visit, and all routine post-fracture management through day 90 — immobilization adjustments, follow-up imaging reviews, and wound care if applicable. E/M services for a new unrelated problem during that global period require modifier 24.

Scapular fractures are uncommon, often high-energy injuries, and frequently associated with other thoracic trauma. Document displacement, fracture classification, glenohumeral or AC joint involvement, and the specific manipulation technique used. Payers will scrutinize whether manipulation was truly performed and clinically warranted versus conservative immobilization alone, which maps to 23570.

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 (4.12) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (13.74) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.12
Practice expense RVU	8.74
Malpractice RVU	0.88
Total RVU	13.74
Medicare national rate	$458.93
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	$458.93
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 23575 get rejected.

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

Insufficient documentation of manipulation — notes that describe only immobilization without confirming a reduction maneuver will be denied or downcoded to 23570
Missing or inadequate pre-procedure imaging to establish fracture diagnosis and displacement requiring manipulation
Global period conflicts — E/M or follow-up services billed without modifier 24 during the 90-day global window
ICD-10 code mismatch — using a closed fracture diagnosis code when imaging or notes indicate an open fracture pattern
Bilateral modifier absent when bilateral scapular injuries are treated in the same session, or incorrectly applied when only one side treated

Frequently asked questions

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

01What is the difference between 23570 and 23575?

23570 is closed treatment without manipulation — the fracture is managed with immobilization only. 23575 requires that the physician actively manipulates (reduces) the fracture, with or without skeletal traction. If your note doesn't document a reduction maneuver, use 23570.

02Is skeletal traction required to bill 23575?

No. The code descriptor includes 'with or without skeletal traction.' Traction may be used to assist reduction but is not required. Document whether it was used regardless, since payers may ask.

03Does shoulder joint involvement change the code?

No, 23575 applies whether or not the glenohumeral joint is involved. Document joint involvement anyway — it supports medical necessity and may affect the fracture classification and ICD-10 code selection.

04How does the 90-day global period affect follow-up billing?

Routine post-fracture management through day 90 is bundled. Bill modifier 24 on an E/M for a new unrelated problem during that window. Use modifier 79 if an unrelated procedure is performed. Use modifier 78 only for a return to manage a complication directly related to the original fracture treatment.

05Can 23575 be billed bilaterally?

Bilateral scapular fractures are rare given the injury mechanism, but if both sides are treated in the same session, append modifier 50. Bill as a single line with modifier 50 per Medicare and most payer rules.

06What ICD-10 codes are typically paired with 23575?

Scapular fracture codes fall under S42.10–S42.19 (fracture of scapula). Specify laterality (right, left) and displacement status. A displaced fracture code best supports medical necessity for manipulation over conservative immobilization.

07When is modifier 22 appropriate for 23575?

Use modifier 22 when the manipulation required substantially greater effort than typical — for example, extreme displacement, significant comminution, or concomitant glenohumeral dislocation requiring separate reduction. Attach a cover letter with objective documentation of the added complexity.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the manipulation technique, traction application status, fracture displacement description, joint involvement, and post-reduction imaging findings directly from the surgeon's dictation. This prevents the most common denial for 23575 — notes that describe immobilization without confirming an active reduction maneuver was performed — and eliminates ambiguity that leads auditors to downcode to 23570.

See how Mira captures CPT 23575 documentation