Closed treatment of a greater tuberosity fracture of the humerus, performed without manipulation of the fracture fragments.

Verified May 8, 2026 · 5 sources ↓

Medicare: $309.63
Work RVU: 2.49
Global, days: 90
Region: Shoulder

Drawn from CMSAAOSAAPCMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Radiographic confirmation of greater tuberosity fracture with imaging report or physician interpretation in the note
Explicit statement that no manipulation was performed and clinical rationale supporting non-operative management
Description of immobilization method applied (e.g., sling, sling-and-swathe) and instructions given to patient
Fracture displacement measurement or qualitative description to justify closed treatment without manipulation
Neurovascular exam of the affected extremity documented in the encounter note
If a concurrent dislocation is present, separate documentation of each distinct injury and its treatment

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 57 Decision for surgery 58 Staged or related 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 5 cited references ↓

CPT 23620 describes non-operative management of a greater tuberosity fracture of the proximal humerus where the treating physician determines no manual reduction is needed. The fracture is addressed through immobilization — typically a sling — with the treating physician providing the initial evaluation, fracture management decision, and follow-up care included in the 90-day global package.

The 90-day global period covers all routine post-fracture visits, dressing changes, and imaging review related to this injury from the service date through day 90. Any E/M service on the day of or day before the fracture management decision should carry modifier 57 if that visit drove the decision to treat. Unrelated E/M visits during the global window require modifier 24.

Greater tuberosity fractures are frequently associated with anterior glenohumeral dislocations. If a dislocation is treated on the same day, verify NCCI bundling rules before reporting both procedures; a modifier may be required to unbundle, but clinical documentation must support that each represents a distinct service. Displacement greater than 5 mm typically prompts operative intervention — if the case crosses into manipulation, 23625 is the correct code.

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 (2.49) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (9.27) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.49
Practice expense RVU	6.28
Malpractice RVU	0.5
Total RVU	9.27
Medicare national rate	$309.63
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	$309.63
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 23620 get rejected.

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

Missing or inadequate imaging documentation — payers require confirmed radiographic diagnosis to support fracture care billing
Claim bundled with a same-day shoulder dislocation reduction code without a modifier to distinguish distinct services
E/M billed same-day without modifier 25, triggering automatic bundling into the fracture care package
Global period conflict — follow-up visits billed within 90 days without modifier 24 for unrelated conditions
Upcoded to 23625 (with manipulation) when operative note or imaging review does not document a reduction maneuver

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What is the global period for CPT 23620?

90 days. The global package includes the treatment date, any day-before visit (with modifier 57 if that visit was the decision for surgery), and all routine follow-up through day 90. Unrelated E/M visits in that window need modifier 24.

02When should I use 23625 instead of 23620?

Use 23625 when you perform a closed reduction — meaning you manually manipulate the fragment or associated joint. If the patient is immobilized without any reduction attempt, 23620 is correct. Document the absence of manipulation explicitly.

03Can I bill 23620 and a dislocation reduction code on the same day?

Possibly, but NCCI PTP edits address this pairing. Check the current NCCI tables. If both services are clinically distinct and separately documented, a modifier may allow separate billing — but attach it only when the documentation supports two distinct procedures, not as a routine bypass.

04Can I bill a same-day E/M with CPT 23620?

Yes, with modifier 25 on the E/M if the visit was a significant, separately identifiable service beyond the pre-service work included in the fracture care code. The note must reflect decision-making or evaluation beyond the fracture itself.

05Does 23620 include follow-up X-rays during the global period?

The professional component of imaging interpretation during the global period is generally bundled. If the facility or a separate radiologist reads the films, the technical and professional components may be billed by those parties — but the treating surgeon cannot separately bill imaging interpretation for the same fracture during the 90-day global.

06Is CPT 23620 appropriate if the greater tuberosity fracture is displaced more than 5 mm?

Displacement greater than 5 mm is the common clinical threshold for considering operative fixation. If you still manage it closed without manipulation, document your clinical rationale clearly. Significant displacement without manipulation may prompt medical necessity review.

07How does site of service affect reimbursement for 23620?

HOPD and ASC payments differ — see the site of service comparison table on this page. The physician's professional fee is also subject to the facility vs. non-facility rate differential under the CMS Physician Fee Schedule 2026.

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 site (greater tuberosity), laterality, displacement measurement or qualitative description, the physician's explicit decision not to manipulate, and the immobilization device applied — all from dictation. This prevents the two most common audit flags: a note that omits the non-manipulation rationale (triggering upcoding scrutiny) and missing laterality that causes claim rejection before it reaches a human reviewer.

See how Mira captures CPT 23620 documentation