Closed treatment of a greater humeral tuberosity fracture using manual manipulation to restore alignment, without surgical incision.

Verified May 8, 2026 · 6 sources ↓

Medicare: $448.24
Total RVUs: 13.42
Global, days: 90
Region: Shoulder

Drawn from CMSEmednyKzanowNovitasAAPC

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Mechanism of injury and clinical findings confirming greater tuberosity fracture location
Pre-procedure imaging (X-ray, CT, or fluoroscopy) documenting fracture displacement or angulation that necessitates manipulation
Type of anesthesia administered (local infiltration, conscious sedation, or general)
Intraoperative narrative describing the manual manipulation technique and endpoint alignment achieved
Post-reduction imaging or fluoroscopy confirmation of satisfactory reduction
Immobilization method applied (sling type, shoulder immobilizer) and instructions provided
Explicit statement that no surgical incision was made — closed treatment only

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 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 23625 covers closed (non-surgical) treatment of a greater humeral tuberosity fracture when manipulation is required to reduce displaced or angulated fragments. The surgeon manually repositions the fracture under anesthesia — local, sedation, or general — typically with fluoroscopic guidance to confirm alignment. Immobilization with a sling or shoulder immobilizer follows. This distinguishes 23625 from its sibling code 23620, which covers the same fracture treated without manipulation.

The 90-day global period bundles the surgery date, all routine post-op shoulder visits, dressings, and immobilizer checks through day 90. Anything unrelated to the tuberosity fracture billed during that window needs modifier 24 (E/M) or 79 (unrelated procedure). A return to address a complication of the original fracture treatment — such as loss of reduction — uses modifier 78.

Do not confuse 23625 with 23665 (shoulder dislocation with associated greater tuberosity fracture, with manipulation) or 23655 (pure shoulder dislocation requiring anesthesia). If both a dislocation and an isolated greater tuberosity fracture are present and treated together, 23665 is the correct single code — not 23625 stacked with 23655.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4
Practice expense RVU	8.54
Malpractice RVU	0.88
Total RVU	13.42
Medicare national rate	$448.24
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	$448.24
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 23625 get rejected.

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

Upcoding flag: billing 23625 when documentation shows no manipulation was performed — should be 23620
Wrong code selection: 23665 is required when a concurrent shoulder dislocation was also manipulated; 23625 alone undercodes that encounter
PA or NP performed the manipulation without supervising physician involvement, triggering CO-B7 Medicare eligibility denials
Missing post-reduction imaging documentation causes payers to question whether manipulation was actually performed
E/M billed same-day as 23625 without modifier 25 and a clearly documented separate, significant evaluation

Frequently asked questions

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

01What is the difference between CPT 23620 and 23625?

23620 is closed treatment without manipulation — the fracture is minimally displaced and managed with immobilization only. 23625 requires active manual manipulation to reduce a displaced fragment. The operative note must explicitly describe the manipulation; absent that language, payers will downcode to 23620.

02Should I bill 23625 or 23665 when the patient has both a shoulder dislocation and a greater tuberosity fracture?

Bill 23665. That code bundles the closed treatment of a shoulder dislocation with an associated greater tuberosity fracture into a single manipulation. Billing 23625 and 23655 together for this scenario is an unbundling error.

03Can a PA bill 23625 independently under Medicare?

No — not independently. The AAPC forum documents a CO-B7 denial pattern when a PA bills fracture care without proper incident-to or split/shared billing rules being met. Verify supervising physician presence and use the correct billing provider NPI.

04Is an E/M billable on the same day as 23625?

Yes, but only if the E/M reflects a significant, separately identifiable service beyond the decision to treat the fracture — and modifier 25 must be appended to the E/M code. The note needs to show separate medical decision-making, not just the fracture evaluation.

05What modifier applies if the patient returns within the 90-day global for loss of reduction requiring repeat manipulation?

Use modifier 78. That signals an unplanned return to the operating or procedure room for a complication related to the original treatment. Do not use modifier 79, which is reserved for procedures unrelated to the original surgery.

06If a patient has a concurrent proximal humerus fracture and a greater tuberosity fracture, can both be billed?

CPT rules allow separate codes for anatomically distinct fractures. However, for Medicare Part B, NCCI edits restrict reporting multiple fracture codes when a single immobilization device is applied without manipulation. Check NCCI edits before billing 23620 or 23625 alongside 23600 or 23605 on the same claim.

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 site (greater tuberosity, not surgical neck or anatomical neck), the explicit statement that treatment was closed, the manipulation technique and endpoint, anesthesia type, fluoroscopic confirmation of reduction, and immobilization device applied. That documentation chain prevents the most common audit flag — a 23625 claim where the operative note fails to distinguish manipulation from simple immobilization, which triggers downcoding to 23620.

See how Mira captures CPT 23625 documentation