Open surgical repair of a scapular fracture — body, glenoid, or acromion — with internal fixation hardware such as plates or screws.

Verified May 8, 2026 · 9 sources ↓

Medicare: $895.48
Total RVUs: 26.81
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCBedrockbillingMdclarityFindacode

Documentation requirements

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

Source · Editorial brief grounded in 9 cited references ↓

Specify the fracture location: body, glenoid, or acromion — vague 'scapula fracture' without anatomic site invites downcoding queries
Describe the degree of displacement and complexity justifying open treatment over closed management
Name the internal fixation hardware used (plate type, screw count/size) and fixation technique in the operative note
Document the surgical approach — posterior Judet, superior, or other named approach — not just 'standard incision'
Record pre-op imaging (CT preferred for complex patterns) confirming fracture anatomy and operative indication
If modifier 22 is appended, provide a separate written narrative detailing the increased complexity beyond typical scapular ORIF

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 9 cited references ↓

CPT 23585 covers open treatment of a scapular fracture involving the body, glenoid, or acromion, with internal fixation performed as part of the same operative session. The surgeon exposes the fracture through a direct incision, reduces displaced fragments, and secures the construct with plates, screws, or a combination. Internal fixation is included in the code and is not separately billable — the 'when performed' language means fixation is bundled regardless of whether it was actually applied.

This code carries a 90-day global period. All routine post-op visits, wound checks, and hardware monitoring within that window are included. Any E/M service for an unrelated condition during the global requires modifier 24; a separate procedure by the same surgeon during the global for a related complication requires modifier 78, and for an unrelated procedure, modifier 79.

Scapular fractures are uncommon, typically result from high-energy trauma, and frequently present alongside ipsilateral injuries — rib fractures, pneumothorax, brachial plexus injury, clavicle fractures. Document all concurrent injuries and procedures carefully; billing a same-session clavicle ORIF (23515) alongside 23585 requires modifier 51 and clear operative note support for each distinct fixation.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	13.87
Practice expense RVU	10.12
Malpractice RVU	2.82
Total RVU	26.81
Medicare national rate	$895.48
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	$895.48
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,935.34

Common denial reasons

The recurring reasons claims for CPT 23585 get rejected.

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

Missing or vague fracture site documentation — payer cannot confirm glenoid vs. body vs. acromion from the operative note
Internal fixation hardware not documented, triggering questions about whether ORIF or closed treatment was actually performed
Global period conflict — post-op E/M billed without modifier 24 or 25, denied as included in the 90-day global
Concurrent procedure (e.g., clavicle ORIF 23515) denied for missing modifier 51 or inadequate separate operative documentation
Lack of pre-operative imaging in the record to support medical necessity for open over non-operative management

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 9 cited references ↓

01Does 23585 include internal fixation, or should fixation be billed separately?

Internal fixation is bundled into 23585. The 'when performed' language in the descriptor means hardware application is included regardless of what was used. Do not separately bill implant placement codes for the same fracture.

02Can 23585 and 23515 (clavicle ORIF) be billed together for the same session?

Yes, if both fractures were treated open in the same operative session. Append modifier 51 to the lower-valued code. The operative note must clearly document separate fixation of each bone.

03What modifier applies when the surgeon returns to the OR during the 90-day global for a hardware failure at the same site?

Modifier 78 — unplanned return to the OR for a related procedure during the postoperative period. Do not use modifier 79, which is for unrelated procedures.

04Is arthroscopic treatment of a scapular fracture reported with 23585?

No. 23585 is an open procedure code. Arthroscopic scapular fracture repair has no dedicated CPT code; some facilities report it as 29999 (unlisted arthroscopy) with 23585 as a comparison code. Confirm with the payer before submission.

05When is modifier 22 appropriate for 23585?

Append modifier 22 when the procedure required substantially greater work than a typical scapular ORIF — for example, a highly comminuted glenoid fracture requiring complex reconstruction or prolonged operative time. You must include a written narrative; modifier 22 without documentation support is routinely denied.

06Can a coracoid process fracture be reported with 23585?

23585 covers body, glenoid, and acromion fractures per its descriptor. Coracoid fractures are anatomically part of the scapula but fall outside the explicit anatomic sites listed. Some coders apply 23585; others use an unlisted code. Query your MAC or payer for guidance before billing.

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 fracture anatomic site (body, glenoid, or acromion), displacement severity, fixation hardware details (plate type, screw count), and the named surgical approach from dictation — the four elements most frequently missing when 23585 claims are audited or denied. Locking that into the operative note at the point of care prevents the post-op documentation scramble that delays clean claim submission.

See how Mira captures CPT 23585 documentation