Closed treatment of shoulder dislocation combined with a fracture of the greater humeral tuberosity, performed with manipulation to restore joint alignment.

Verified May 8, 2026 · 6 sources ↓

Medicare: $498.34
Work RVU: 4.54
Global, days: 90
Region: Shoulder

Drawn from CMSNIHMdclarityEmednyCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Imaging confirmation of both glenohumeral dislocation and greater humeral tuberosity fracture prior to manipulation
Post-reduction imaging documenting restored joint alignment and fracture position
Anesthesia type used during manipulation (conscious sedation, regional block, or general)
Specific manipulation technique performed and the treating physician's clinical findings
Immobilization method applied post-reduction (sling, shoulder immobilizer, etc.)
Neurovascular assessment before and after reduction, particularly axillary nerve status

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 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 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 23665 covers closed (non-operative) reduction of a glenohumeral dislocation that occurs alongside a fracture of the greater humeral tuberosity. Manipulation is required and inherent to the code — there is no separate non-manipulation variant for this injury combination. The code bundles the reduction maneuver, any associated fracture management, and application of immobilization as needed.

The 90-day global period covers the day-before visit, the procedure itself, and all routine post-op care through day 90. Any E/M visit for an unrelated condition during that window requires modifier 24. If the injury requires escalation to open treatment (23670), that represents a distinct code and clinical scenario — don't use 23665 when internal fixation is performed.

Fluoroscopic confirmation of reduction is integral to the procedure and cannot be billed separately. Document pre- and post-reduction imaging findings, anesthesia type, and the specific manipulation technique in the operative note. Injuries involving the surgical or anatomical neck instead map to 23675 (closed) or 23680 (open) — verify fracture location on imaging before selecting 23665.

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 (4.54) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (14.92) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.54
Practice expense RVU	9.38
Malpractice RVU	1
Total RVU	14.92
Medicare national rate	$498.34
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	$498.34
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 23665 get rejected.

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

Fracture location not documented — payers deny when imaging reports reference 'proximal humerus' without specifying the greater tuberosity
Fluoroscopy billed separately — it is integral to 23665 and will be bundled and denied
Wrong code selected when internal fixation was performed — 23665 is closed treatment only; open fixation maps to 23670
Missing post-reduction imaging documentation to support that manipulation was actually performed and successful
E/M billed same-day without modifier 25, resulting in denial of the evaluation and management service

Frequently asked questions

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

01Is manipulation always required for 23665, or is there a without-manipulation variant?

Manipulation is always required for 23665. There is no closed-without-manipulation option for this injury combination. If the dislocation reduces spontaneously without physician manipulation, 23665 does not apply.

02Can fluoroscopy or post-reduction X-rays be billed separately with 23665?

No. Radiologic guidance and imaging used to confirm reduction are integral to the procedure. Bill only 23665. If a separate imaging study is ordered on the same day for a distinct clinical purpose unrelated to the reduction, that may be billable with modifier 59/XS and solid documentation of medical necessity.

03What is the correct code if the surgeon ends up performing open reduction with internal fixation of the tuberosity fracture?

Use 23670 instead. That code covers open treatment of glenohumeral dislocation with greater humeral tuberosity fracture and includes internal fixation when performed. Never append 23665 and 23670 together for the same shoulder on the same date.

04How does the 90-day global period affect billing for follow-up shoulder care after 23665?

All routine post-reduction visits, cast or sling checks, and suture/staple removal within 90 days are included in the global. Append modifier 24 on any E/M that addresses a condition unrelated to the original injury. If the patient develops a complication requiring a return to the OR for a related procedure, use modifier 78.

05Can 23665 be billed bilaterally with modifier 50?

Simultaneous bilateral shoulder dislocation-fractures are exceedingly rare, but modifier 50 is technically applicable if both shoulders are treated at the same session with documented bilateral injuries. Expect scrutiny — document each shoulder's dislocation and tuberosity fracture independently in the operative note.

06What ICD-10 diagnosis codes are typically paired with 23665?

The injury typically maps to S40-S49 shoulder and upper arm injury codes, specifically combination codes for glenohumeral dislocation with associated greater tuberosity fracture. Use the most specific laterality code available (right, left, or unspecified). Code the dislocation and fracture as a combination when ICD-10 provides one, rather than listing them separately.

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 location (greater humeral tuberosity, not surgical or anatomical neck), dislocation direction, manipulation technique, anesthesia type, and pre- and post-reduction neurovascular findings directly from dictation. This prevents the most common denial trigger for 23665: records that document a proximal humerus injury without specifying tuberosity involvement, which auditors and payers treat as insufficient to support the code.

See how Mira captures CPT 23665 documentation