Closed reduction of a shoulder dislocation performed with manual manipulation and without anesthesia, treating glenohumeral joint displacement non-operatively.

Verified May 8, 2026 · 6 sources ↓

Medicare: $433.88
Total RVUs: 12.99
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCMdclarityFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm and document that no anesthesia was administered during the reduction procedure
Record the mechanism of injury and clinical findings confirming glenohumeral dislocation (direction, neurovascular status)
Document the specific manipulation technique used to achieve reduction
Note pre- and post-reduction neurovascular and range-of-motion assessment
Include imaging findings (pre-reduction X-ray confirming dislocation, post-reduction X-ray confirming restoration of alignment)
Document post-reduction immobilization plan and follow-up instructions

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 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 6 cited references ↓

CPT 23650 covers closed treatment of a shoulder dislocation — typically glenohumeral — where the physician manually reduces the joint without anesthesia. The procedure involves physical manipulation to restore normal joint alignment, followed by confirmation of reduction. Because no anesthesia is administered, patient cooperation and physician technique are central to success. This code carries a 90-day global period, meaning pre-op visits, the reduction itself, and all routine post-reduction follow-up are bundled. Bill separately only for services unrelated to the dislocation during that window, and append modifier 24 or 25 as appropriate.

This code commonly appears in emergency department and office settings. When the ER performs the reduction and a separate orthopedic practice handles all follow-up, split the global using modifier 54 (surgical care only) on the ER claim and modifier 55 (post-op management only) on the follow-up provider's claim. If a significant, separately identifiable E/M is performed on the same day as the reduction — for example, evaluating a new patient with multiple complaints before deciding on closed reduction — append modifier 25 to the E/M code, not to 23650 itself.

When anesthesia is required for the reduction, use 23655 instead. If the dislocation is associated with a greater tuberosity fracture, 23665 is the correct code. Open treatment of an acute shoulder dislocation is reported with 23660. Selecting the wrong variant is one of the most common audit flags for this family of codes.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	3.44
Practice expense RVU	8.73
Malpractice RVU	0.82
Total RVU	12.99
Medicare national rate	$433.88
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	$433.88
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI A2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 23650 get rejected.

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

Wrong code selected — 23655 (with anesthesia) or 23665 (with associated tuberosity fracture) should have been used instead
Missing modifier 25 on a same-day E/M when the E/M was billed alongside 23650 without documenting a significant, separately identifiable service
Modifier 54/55 split-global not coordinated between ER and follow-up provider, resulting in duplicate global billing
Lack of pre- and post-reduction imaging documentation to support medical necessity of the manipulation
Routine post-reduction follow-up visits billed separately during the 90-day global period without modifier 24 or 79

Frequently asked questions

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

01What is the difference between CPT 23650 and 23655?

23650 is used when the shoulder dislocation is reduced without anesthesia. 23655 applies when anesthesia is required to achieve reduction. Billing 23650 when anesthesia was administered is incorrect and audit-prone — document clearly which scenario occurred.

02Can I bill an E/M on the same day as 23650?

Yes, but only if the E/M is significant and separately identifiable from the decision to perform the reduction. Append modifier 25 to the E/M code. Some payers — especially BCBS plans — scrutinize this combination closely; document the distinct medical decision-making clearly in the note.

03How do the ER physician and the orthopedic follow-up provider split the global?

The ER physician who performs the reduction bills 23650 with modifier 54 (surgical care only). The orthopedic provider handling all post-reduction follow-up bills 23650 with modifier 55 (post-op management only). Both providers must coordinate to avoid duplicate payment for the full global package.

04What happens if the same shoulder dislocates again during the 90-day global period?

A new dislocation event is not a routine post-op service — it's a new injury. Bill 23650 again with modifier 79 (unrelated procedure during post-op period) to indicate this is a distinct, unrelated service, not a complication of the original reduction.

05Is CPT 23650 appropriate when the dislocation is associated with a greater tuberosity fracture?

No. When a greater tuberosity fracture accompanies the dislocation and is treated with closed manipulation, use 23665. Using 23650 in that scenario undercodes the encounter and misrepresents the complexity of care provided.

06Can 23650 be billed bilaterally?

Bilateral shoulder dislocation is exceedingly rare but theoretically billable. If both shoulders are reduced in the same session, append modifier 50. Document each shoulder's dislocation, reduction technique, and post-reduction findings separately in the note.

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 dislocation direction, mechanism of injury, manipulation technique used, absence of anesthesia, and pre- and post-reduction neurovascular and imaging findings directly from dictation. This ensures the operative note explicitly supports 23650 over 23655 or 23665 — the distinction auditors check first — and flags when a same-day E/M needs modifier 25 documentation.

See how Mira captures CPT 23650 documentation