Closed reduction of a shoulder joint dislocation performed under anesthesia, without surgical incision.

Verified May 8, 2026 · 6 sources ↓

Medicare: $418.85
Total RVUs: 12.54
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCFindacodeMdclarityAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify type of anesthesia administered (general, regional block, IV sedation) — absence of this detail is the top reason 23655 gets downcoded to 23650
Document pre- and post-reduction neurovascular status, including axillary nerve motor and sensory function
Record reduction technique used by name (e.g., Cunningham, Stimson, external rotation, traction-countertraction)
Include post-reduction imaging confirmation (X-ray or fluoroscopy) showing successful reduction
Note dislocation direction (anterior, posterior, inferior) and whether first-time or recurrent event
Document clinical indication for anesthesia — e.g., severe muscle spasm, patient inability to relax, failed attempt without anesthesia

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 76 Repeat, same physician 77 Repeat, another physician 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 23655 covers closed reduction of a shoulder dislocation where anesthesia — general, regional, or IV sedation — is required to achieve successful manipulation. The anesthesia requirement is what separates this code from 23650, which is the same procedure performed without anesthesia. Most glenohumeral dislocations are anterior; posterior and inferior dislocations are less common but equally covered under this code when reduction requires anesthesia.

The 90-day global period means all routine follow-up care — sling checks, neurovascular reassessments, and follow-up imaging reviews — is bundled through day 90. Any separately identifiable E/M for an unrelated problem during that window requires modifier 24. If the shoulder redislocates and requires a repeat closed reduction, use modifier 76 (same physician) or 77 (different physician).

Document the anesthesia type used, reduction technique (e.g., Cunningham, Stimson, external rotation), confirmation of reduction by post-procedure imaging, pre- and post-reduction neurovascular status (axillary nerve check is essential), and whether the dislocation was first-time or recurrent. Payers will deny 23655 if documentation supports that no anesthesia was administered — that scenario belongs under 23650.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4.64
Practice expense RVU	6.88
Malpractice RVU	1.02
Total RVU	12.54
Medicare national rate	$418.85
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	$418.85
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 23655 get rejected.

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

Anesthesia not documented: payer downcodes to 23650 when the record doesn't explicitly state anesthesia was administered
Missing post-reduction imaging: insufficient evidence that reduction was achieved under this encounter
Unbundling the anesthesia professional service without coordinating with the anesthesia provider's separate claim — causes duplicate billing flags
E/M billed same-day without modifier 25, resulting in denial of the office visit component
Bilateral modifier 50 applied incorrectly — simultaneous bilateral shoulder dislocation is rare; payer may deny without supporting imaging and clinical documentation

Frequently asked questions

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

01What distinguishes 23655 from 23650?

Anesthesia. CPT 23650 is closed shoulder reduction without anesthesia; 23655 requires that anesthesia — general, regional, or IV sedation — was actually administered. If you bill 23655 and the note doesn't document anesthesia, expect a downcode to 23650.

02Can I bill an E/M visit on the same day as 23655?

Yes, with modifier 25 on the E/M. The E/M must be a separately identifiable service — typically the initial assessment and decision to reduce under anesthesia. Document the decision-making independently from the procedure note.

03The shoulder redislocated two weeks later and I reduced it again. How do I bill the repeat?

Use 23655 again with modifier 76 if you're the same physician, or modifier 77 if a different physician performed the second reduction. The 90-day global from the first procedure doesn't bundle a repeat dislocation — that's a new injury event.

04Does 23655 cover posterior shoulder dislocations?

Yes. The code applies to shoulder joint dislocations regardless of direction — anterior, posterior, or inferior — as long as manipulation under anesthesia is performed. Document the dislocation direction in the note.

05What follow-up is bundled in the 90-day global?

All routine post-reduction care: sling management, wound checks if any, repeat neurovascular assessments, and review of follow-up imaging ordered as part of standard post-reduction care. Use modifier 24 for any E/M visits unrelated to the shoulder dislocation during the global period.

06Can modifier 22 be used if the reduction was unusually difficult?

Yes. If the reduction required substantially more work — for example, multiple technique attempts, prolonged time, or significant anatomical complexity such as a locked posterior dislocation — append modifier 22 and include a separate cover letter quantifying the additional time and effort. Payers require documentation that specifically supports the increased work.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures anesthesia type, reduction technique by name, dislocation direction, pre- and post-reduction neurovascular findings including axillary nerve status, and post-reduction imaging result directly from dictation. That prevents the most common audit flag on 23655 — a note that reads like a 23650 because anesthesia and technique details were never documented.

See how Mira captures CPT 23655 documentation