Open treatment of a shoulder dislocation combined with open reduction of a greater tuberosity fracture, with or without internal fixation.

Verified May 8, 2026 · 5 sources ↓

Medicare: $817.65
Total RVUs: 24.48
Global, days: 90
Region: Shoulder

Drawn from CMSCgsmedicareAAPC

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Confirm both pathologies are present: document the dislocation AND the greater tuberosity fracture explicitly in the operative note — not just 'shoulder injury'.
State the surgical approach by name (e.g., deltopectoral, anterosuperior); notes that say 'standard approach' flag on audit.
Document whether internal fixation was used and specify implant type (screws, suture anchors, plates) and placement; this supports medical necessity and implant billing.
Record intraoperative imaging or fluoroscopy use and confirm reduction quality post-fixation — necessary if reporting guidance separately.
Pre-op imaging (X-ray or CT) in the chart must demonstrate the fracture-dislocation pattern matching the CPT selected; mismatched imaging and operative note is a top audit trigger.
If modifier 22 is appended, the operative note must contain a specific narrative explaining what made the case significantly more complex than typical — time alone is insufficient.

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 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 62 Co-surgeons 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 5 cited references ↓

CPT 23670 covers open surgical treatment of a simultaneous shoulder dislocation and fracture of the greater tuberosity of the humerus. The surgeon opens the joint, reduces the dislocation, and addresses the tuberosity fracture — with or without internal fixation hardware such as screws or suture anchors. This is a distinct, more complex procedure than either open dislocation reduction alone (23655) or isolated greater tuberosity fracture repair (23630).

The 90-day global period means the surgery, the day-before visit, and all routine postoperative care through day 90 are bundled into the single payment. E/M services during that window require modifier 24 if unrelated to the shoulder, or modifier 79 for an unrelated surgical procedure. Any staged or planned return to address a separate shoulder problem uses modifier 58; an unplanned return for a related complication uses modifier 78.

For facility billing, note the significant payment differential between HOPD and ASC settings — see the Site of Service comparison table. Unilateral procedures should carry modifier LT or RT. If unusual complexity genuinely drives substantially increased intraoperative time and work (e.g., severely comminuted tuberosity, prior hardware, extensive soft-tissue damage), modifier 22 applies with a supporting operative note narrative; without that narrative, the modifier will deny.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	11.97
Practice expense RVU	9.99
Malpractice RVU	2.52
Total RVU	24.48
Medicare national rate	$817.65
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	$817.65
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 23670 get rejected.

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

Coding 23655 and 23630 separately on the same claim when combined open treatment warrants 23670 — results in a bundling denial.
Missing or inadequate documentation of the tuberosity fracture component; payers downcode to 23655 (dislocation only) without fracture confirmation.
Modifier 22 appended without a supporting operative note narrative explaining the specific complexity factors.
Modifier LT or RT absent on unilateral claims at facilities requiring laterality for shoulder procedures.
Global period violations — E/M services billed during the 90-day window without modifier 24 or 25 as appropriate.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01When does a case warrant 23670 instead of billing 23655 and 23630 together?

23670 is the correct single code when the surgeon performs open treatment of both the dislocation and the greater tuberosity fracture in the same operative session. Billing 23655 and 23630 together for the same shoulder on the same date creates a bundling conflict — 23670 is the comprehensive code for this combined scenario.

02Can I bill 23670 if the tuberosity fracture was treated closed and only the dislocation required open reduction?

No. 23670 requires open treatment of both components. If the tuberosity fracture was managed closed and only the dislocation was opened, consider 23655 for the open dislocation reduction. Document clearly which components were treated open versus closed.

03Does the 90-day global include physical therapy or occupational therapy visits?

No. The 90-day global covers the operating surgeon's E/M and surgical services only. PT and OT are billed separately by the therapist and are not bundled into the surgeon's global package.

04Is modifier 50 appropriate if both shoulders are treated during the same session?

Bilateral shoulder fracture-dislocation is extremely rare, but if it occurs, use modifier 50 on a single claim line for physician billing. ASC facilities should use two claim lines with LT and RT respectively, per NCCI billing rules.

05Can a separate radiologic guidance code be billed with 23670 for intraoperative fluoroscopy?

Only if the fluoroscopy was used for a separately identifiable additional procedure. Intraoperative imaging used to confirm reduction of the fracture-dislocation is generally considered integral to the open procedure and is not separately reportable. Review NCCI Chapter 4 guidance on integral fluoroscopy before appending an imaging code.

06What ICD-10 diagnosis codes should be paired with 23670?

The claim needs both a shoulder dislocation code and a greater tuberosity fracture code — typically from the S40–S49 range. Using a dislocation-only or fracture-only diagnosis while billing 23670 invites a medical necessity denial, since the CPT implies combined pathology.

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 reduction technique, fracture pattern (greater tuberosity involvement, displacement, comminution), fixation method and implant specifics, surgical approach name, and intraoperative confirmation of reduction from the surgeon's dictation. This prevents the most common downcode — payers reverting to 23655 when fracture treatment isn't explicitly documented — and supplies the operative note detail needed to defend modifier 22 if complexity is flagged on audit.

See how Mira captures CPT 23670 documentation