Closed treatment of a proximal humeral fracture (surgical or anatomical neck) without manipulation — no reduction and no open surgery performed.

Verified May 8, 2026 · 8 sources ↓

Medicare: $381.10
Work RVU: 2.93
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCMdclarityCgsmedicareFindacode

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Imaging report confirming fracture location at surgical or anatomical neck of the proximal humerus
Clinical rationale for non-operative management — document fracture alignment and why manipulation was not required
Laterality documented explicitly (left, right, or bilateral) in the operative/procedure note and on the claim
Type of immobilization applied (sling, sling-and-swathe, coaptation splint) and instructions given to patient
Neurovascular assessment of the affected extremity documented in the encounter note
Date of initial injury and whether this is an initial encounter, subsequent encounter, or sequela — drives correct ICD-10 7th character

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 52 Reduced services 58 Staged or related 59 Distinct service 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 8 cited references ↓

CPT 23600 covers non-operative management of a proximal humeral fracture at the surgical or anatomical neck when the fracture is acceptably aligned and does not require reduction. The physician evaluates the fracture, confirms positioning with imaging, and initiates immobilization — typically a sling or sling-and-swathe. No manipulation of the fracture fragments and no open surgical intervention is performed. The 90-day global period begins on the date of service and includes all routine follow-up visits, imaging interpretation related to fracture monitoring, and dressing management through day 90.

If a separate and significant E&M is performed on the same date — for example, a new patient evaluation in the ED or office before the fracture care decision is finalized — append modifier 25. If a treating physician takes over care after another provider performed the initial fracture management, use modifiers 54 and 55 to split surgical and post-op management billing appropriately. Any E&M during the 90-day global for a condition unrelated to the fracture requires modifier 24.

Common ICD-10 pairings include S42.201A–S42.209A (unspecified proximal humerus fracture, initial encounter) and more specific codes distinguishing surgical from anatomical neck involvement. Laterality matters — confirm LT or RT on every claim. Bilateral proximal humeral fractures are rare but use modifier 50 when both sides are treated at the same encounter.

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 (2.93) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (11.41) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.93
Practice expense RVU	7.87
Malpractice RVU	0.61
Total RVU	11.41
Medicare national rate	$381.10
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	$381.10
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI P2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 23600 get rejected.

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

Missing or mismatched laterality — claim filed without LT/RT modifier when payer requires it, or modifier conflicts with ICD-10 laterality code
Global period overlap — E&M billed during the 90-day post-op window without modifier 24 to establish an unrelated diagnosis
Upcoding concern when documentation does not explicitly state no manipulation was performed, triggering review against 23605 (with manipulation)
ICD-10 7th character error — using 'A' (initial encounter) on a follow-up visit or 'D' (subsequent) on the date of injury
Unbundling of same-day imaging interpretation without appropriate NCCI modifier when fluoroscopy or X-ray supervision and interpretation codes are billed alongside 23600

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01What is the difference between CPT 23600 and 23605?

23600 is closed treatment without manipulation — the fracture is adequately aligned and no reduction is attempted. 23605 is closed treatment with manipulation, meaning the physician actively reduces the fracture fragments. Document explicitly which was performed; the absence of a manipulation statement in the note is an audit red flag.

02Can I bill an E&M on the same day as 23600?

Yes, if the E&M is significant and separately identifiable — for example, a new patient evaluation before the fracture care decision. Append modifier 25 to the E&M. If the E&M is purely to initiate fracture care, it bundles into 23600 and is not separately billable.

03Does the 90-day global period include follow-up X-rays?

Routine fracture follow-up imaging interpretation during the global period is bundled. If a new, unrelated condition requires imaging, that may be separately billable with modifier 24 on any associated E&M. Do not bill separate supervision and interpretation codes for standard fracture monitoring films.

04What modifier do I use if the patient transfers care to a different orthopedist during the global period?

The original treating physician bills 23600 with modifier 54 (surgical care only). The receiving physician bills with modifier 55 (postoperative management only) and documents the date they assumed care. Both providers' global periods must be coordinated so total reimbursement does not exceed 100% of the allowed amount.

05Is modifier 57 appropriate when the decision for fracture care is made in the ED?

No. Modifier 57 applies when the E&M leads to the decision to perform major surgery (90-day global). CMS and AAPC guidance is clear: 23600 carries a 90-day global, so modifier 57 is technically applicable in concept — but if the treating ED physician performs both the E&M and the fracture care on the same date, the E&M bundles unless a significant separately identifiable service exists, in which case modifier 25 on the E&M is the correct approach.

06When would modifier 22 apply to 23600?

Modifier 22 is appropriate when the work is substantially greater than typical — for example, managing a comminuted proximal humeral fracture with extensive clinical complexity, prolonged immobilization fitting, or a patient with severe osteoporosis requiring extended counseling. The operative note must clearly document the additional time and complexity. Payers require supporting documentation and may request records before paying the increase.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the fracture location (surgical vs. anatomical neck), explicit statement that no manipulation was performed, immobilization type applied, laterality, and neurovascular exam findings — all from dictation. That prevents the most common audit flag for 23600: an operative note that omits confirmation of no reduction, which reviewers use to question whether 23605 should have been billed instead.

See how Mira captures CPT 23600 documentation