Closed reduction of a proximal humeral surgical or anatomical neck fracture with manipulation, with or without skeletal traction — no surgical incision required.

Verified May 8, 2026 · 6 sources ↓

Medicare: $534.75
Work RVU: 4.93
Global, days: 90
Region: Shoulder

Drawn from CMSBedrockbillingMdclarityAAPC

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify fracture location as surgical neck or anatomical neck of the proximal humerus — generic 'proximal humerus fracture' is insufficient for audit purposes.
Document the manipulation technique used to achieve reduction, including whether skeletal traction was applied and how.
Record pre- and post-reduction imaging results confirming fracture alignment and reduction quality.
Note laterality explicitly (left, right, or bilateral) in both the operative note and the diagnosis coding.
Document neurovascular status of the extremity before and after manipulation, including axillary nerve and brachial plexus assessment.
If complexity was substantially greater than typical — comminution, patient body habitus, associated dislocation — document specifics to support modifier 22 if appended.

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 57 Decision for surgery 58 Staged or related 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 6 cited references ↓

CPT 23605 covers closed treatment of a proximal humeral fracture at the surgical or anatomical neck, performed with manipulation to restore alignment. Traction — including skeletal traction — may be used but is not required. The defining element is that no open incision is made; if the surgeon opens the fracture site, a different code applies. This is a 90-day global procedure, meaning all routine post-fracture management through day 90 is bundled.

The 90-day global period includes the day-before visit, the reduction itself, and all follow-up visits for fracture management through the global window. Immobilization (sling, coaptation splint) applied at the time of reduction is also bundled — do not separately bill casting or strapping codes for the initial application. Post-reduction imaging is separately billable; document that it was used to confirm reduction.

If the closed reduction is attempted and the surgeon then proceeds to open treatment in the same operative session, 23605 is not separately reportable — bill only the open procedure code. If the treating physician transfers care (surgical-only or post-op management only), use modifiers 54 and 55 accordingly to split the global.

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 (4.93) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (16.01) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.93
Practice expense RVU	10
Malpractice RVU	1.08
Total RVU	16.01
Medicare national rate	$534.75
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	$534.75
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 23605 get rejected.

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

Fracture location not specified as surgical or anatomical neck — payers reject claims when the operative note says 'proximal humerus' without neck-level detail.
Bundling denial when 23605 is billed same-session as the open reduction code 23615; if the surgeon converted to open treatment, bill only the open procedure.
Missing laterality modifier (LT or RT) triggers claim suspension or denial from Medicare and most commercial payers.
Casting or strapping code billed separately on the same date — initial immobilization is bundled into the global; separate billing requires a distinct clinical indication.
Post-reduction E/M billed during the 90-day global without modifier 24, causing denial as a bundled service when the visit is unrelated to the fracture.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What is the difference between CPT 23600 and CPT 23605?

23600 is closed treatment without manipulation — the fracture is managed with immobilization only. 23605 requires documented manipulation to reposition the fracture fragments. Bill 23605 only when active reduction was performed and documented.

02Can I bill 23605 if I attempted closed reduction and then converted to open treatment in the same session?

No. If you convert to open treatment in the same session, bill only the open procedure code (e.g., 23615). The attempted closed reduction is not separately reportable — it is considered part of the surgical approach to the open procedure.

03Do I need a laterality modifier for 23605?

Yes. Append LT or RT on every claim. Medicare and most commercial payers require laterality for shoulder procedures. Bilateral fractures treated in the same session use modifier 50.

04Is post-reduction imaging separately billable with 23605?

Yes. Imaging to confirm reduction is not bundled into 23605 and may be billed separately. Document in the operative note that fluoroscopy or plain films were obtained and used to guide or confirm the reduction.

05How does the 90-day global period affect billing for shoulder fracture follow-up visits?

All routine fracture management visits within 90 days are bundled — do not bill them separately. If a follow-up visit addresses a problem unrelated to the fracture, append modifier 24 to the E/M code and document the unrelated diagnosis clearly. Modifier 25 is for same-day E/M when a separately identifiable decision is made on the day of the procedure itself.

06When is modifier 22 appropriate for 23605?

Use modifier 22 when the reduction required substantially greater work than typical — severe comminution, associated glenohumeral dislocation requiring separate reduction, or extreme patient factors. The operative note must detail the added complexity; a bare modifier 22 without documentation will be stripped on audit.

07Can 23605 and an E/M code be billed on the same day in the emergency department?

Yes, if a significant, separately identifiable evaluation and management service was performed beyond the decision to treat the fracture. Append modifier 25 to the E/M code and document the separate medical decision-making. Without modifier 25, the E/M bundles into 23605.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures fracture location (surgical vs. anatomical neck), manipulation technique, traction use, pre- and post-reduction imaging findings, and neurovascular exam from dictation — populating the operative note fields that auditors and payers check first. This prevents the most common 23605 denial: a note that confirms a proximal humerus fracture was treated but doesn't establish neck-level specificity or confirm that reduction was achieved and confirmed radiographically.

See how Mira captures CPT 23605 documentation