Open surgical treatment of an acute shoulder dislocation, involving direct incision to expose and reduce the dislocated glenohumeral joint.

Verified May 8, 2026 · 6 sources ↓

Medicare: $551.11
Total RVUs: 16.5
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCFindacodeMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the direction of dislocation (anterior, posterior, inferior) in the operative note — 'shoulder dislocation' alone is insufficient for audit defense.
Document the reason open treatment was selected over closed reduction (e.g., failed closed attempt, neurovascular compromise, locked posterior dislocation, associated fracture).
Name the surgical approach used — deltopectoral, posterior, or other — not just 'standard approach'; audit teams flag vague approach language.
Record all intraoperative findings, including any associated soft-tissue or osseous pathology identified and whether additional repairs were performed.
Note anesthesia type and confirm it was provided by a separate anesthesiologist if billing for the surgical procedure; physician-administered anesthesia is bundled per NCCI.
Post-reduction imaging (fluoroscopy or plain film) confirming reduction should be referenced in the operative note to support medical necessity.

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 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 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 23660 covers open treatment of an acute shoulder dislocation — a surgical approach where the surgeon makes an incision to directly visualize and reduce the displaced humeral head. This is distinct from closed manipulation; use 23660 only when an open approach is performed. The code is most commonly applied to posterior dislocations, where closed reduction has failed or is contraindicated, though it is not limited to that direction.

The procedure carries a 90-day global period. That window includes the day-before visit, the surgery itself, and all routine post-op care through day 90 — sling management, wound checks, and staple removal. Any E&M visit during the global period for an unrelated condition requires modifier 24. Casting, splinting, and strapping applied as part of the dislocation treatment are bundled into 23660 per NCCI policy and cannot be billed separately.

If an arthroscopic approach is attempted and converted to open, bill only the open code (23660) — do not append the arthroscopy code. Additional repairs performed through the same incision (tendon, ligament, bone) should be reviewed for NCCI bundling status before billing separately. Document any co-surgeons under modifier 62 if applicable, and confirm assistant-surgeon eligibility with the payer before billing modifier 80.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.47
Practice expense RVU	7.55
Malpractice RVU	1.48
Total RVU	16.5
Medicare national rate	$551.11
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	$551.11
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 23660 get rejected.

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

Billing a closed-treatment code (23650 or 23655) when the operative report clearly documents an open incision — or the reverse, upcoding to 23660 without documentation of an open approach.
Separate billing for casting, splinting, or strapping applied during or immediately after the procedure — those services are bundled into 23660 per NCCI policy.
E&M claims during the 90-day global period submitted without modifier 24 (unrelated) or 25 (same-day, separately identifiable), triggering automatic denial.
Missing or insufficient medical necessity documentation — payers require clear rationale for open versus closed treatment, especially for first-time dislocations.
Arthroscopy code billed alongside 23660 when the case started arthroscopically and was converted to open — only the open code is billable after conversion.

Frequently asked questions

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

01When do I use 23660 instead of 23650 or 23655?

Use 23660 only when an incision is made to directly access and reduce the joint — that's the open approach. Use 23650 for closed reduction without anesthesia and 23655 for closed reduction requiring anesthesia. The operative note drives the code; if there's no incision documented, 23660 will deny.

02Can I bill separately for the sling or immobilizer applied after open reduction?

No. Casting, splinting, and strapping applied as part of the dislocation treatment are bundled into 23660 under NCCI policy. Billing them separately will generate an NCCI edit denial.

03If we started arthroscopically and converted to open, can I bill both the arthroscopy and 23660?

No. When a surgical arthroscopy is converted to an open procedure, only the open procedure code is reportable. Neither a diagnostic nor a surgical arthroscopy code can be appended to 23660 in that scenario per NCCI guidelines.

04What modifier applies if the surgeon sees the patient in the ED, decides surgery is needed, and performs 23660 the same day?

Attach modifier 57 to the E&M service. Modifier 57 signals that the E&M resulted in the decision to perform a major surgery (90-day global). Without it, the E&M will be denied as bundled into the global package.

05Is modifier 50 ever appropriate for 23660?

Bilateral shoulder dislocation treated open at the same operative session is rare, but if it occurs, modifier 50 is applicable. Confirm with your payer — some require LT and RT on separate lines rather than modifier 50 on a single line.

06Can additional soft-tissue repairs performed through the same incision be billed separately?

It depends on the specific code pair. Check NCCI PTP edits for each additional procedure before billing. Some associated repairs are bundled into 23660; others may be separately reportable with modifier 59 if they represent a distinct service with supporting documentation.

07What ICD-10 diagnosis codes should be paired with 23660?

Pair with an acute traumatic shoulder dislocation code from the S43 category — specify laterality and episode of care (initial encounter, subsequent encounter). Chronic dislocation does not support 23660; a different procedure code applies for chronic cases.

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 (anterior, posterior, inferior), the surgeon's stated rationale for open versus closed treatment, the named surgical approach, all intraoperative findings including soft-tissue or bony pathology, and whether additional repairs were performed. This prevents the most common audit flag on 23660: an operative note that documents an open incision but omits the clinical reason the open approach was chosen, which payers treat as a missing medical necessity statement.

See how Mira captures CPT 23660 documentation