Closed treatment of a shoulder dislocation combined with a surgical or anatomical neck fracture of the humerus, with manipulation

Verified May 8, 2026 · 7 sources ↓

Medicare: $629.27
Work RVU: 6.11
Global, days: 90
Region: Shoulder

Drawn from CMSAAPCAAOS

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify dislocation direction (anterior, posterior, or inferior) and confirm glenohumeral joint involvement
Identify fracture location as surgical neck or anatomical neck of the humerus — not just 'proximal humerus fracture'
Document the manipulation technique and confirm reduction was achieved
Include post-procedure imaging (AP and axillary or scapular Y radiographs) confirming reduction of both the dislocation and the fracture
Record neurovascular status before and after reduction, including axillary nerve and brachial plexus assessment
Document immobilization type applied (sling, shoulder immobilizer) and discharge instructions given

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 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 7 cited references ↓

CPT 23675 covers closed (non-operative) management of a simultaneous glenohumeral dislocation and humeral surgical or anatomical neck fracture, where the treating physician manually reduces both the dislocation and the fracture and performs manipulation of the shoulder joint — all without open surgical exposure. This is a higher-complexity injury combination than a pure dislocation, which is why it sits above 23665 (fracture-dislocation of the greater humeral tuberosity) and commands greater work RVUs than standalone dislocation codes.

The 90-day global period means all routine post-reduction care — follow-up visits, repeat imaging to confirm maintained reduction, sling management, and suture or staple removal — is bundled into the single payment. Any visit for an unrelated problem during that window requires modifier 24 on the E/M. If a subsequent procedure becomes necessary for a related complication (e.g., loss of reduction requiring additional manipulation), that encounter bills with modifier 78. An unrelated surgical procedure in the global uses modifier 79.

Document the injury pattern precisely: confirm both the dislocation direction (anterior, posterior, inferior) and the fracture location (surgical neck vs. anatomical neck) in the operative or procedure note. Imaging confirmation of the reduction — typically post-procedure radiographs — is expected. If anesthesia was required for manipulation, that is reported separately by the anesthesiologist; the surgeon does not add a modifier to 23675 to indicate anesthesia use.

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 (6.11) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (18.84) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.11
Practice expense RVU	11.4
Malpractice RVU	1.33
Total RVU	18.84
Medicare national rate	$629.27
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	$629.27
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 23675 get rejected.

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

Diagnosis code does not specify both a dislocation and a proximal humeral neck fracture — a pure dislocation ICD-10 alone will not support 23675
Upcoding flag when clinical documentation describes only a dislocation reduction with no fracture component addressed
Global period conflict — a routine follow-up E/M billed without modifier 24 during the 90-day global is denied as bundled
Missing post-reduction imaging report in the record, triggering medical necessity denial on audit
Procedure billed with modifier 50 (bilateral) — traumatic shoulder fracture-dislocations are virtually never bilateral; payers flag this automatically

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What separates 23675 from 23655 (closed dislocation treatment with manipulation)?

23655 covers a pure glenohumeral dislocation with manipulation. 23675 requires a concurrent surgical or anatomical neck fracture documented and addressed in the same encounter. If there is no fracture, 23655 is correct.

02Should I bill 23675 or 23665 when the fracture involves the greater tuberosity?

Use 23665 for a dislocation with a greater tuberosity fracture. Reserve 23675 specifically for dislocation combined with a surgical neck or anatomical neck fracture. The fracture location drives the code selection.

03Is anesthesia for the manipulation billed separately by the surgeon?

No. The surgeon bills 23675 regardless of whether anesthesia was used. The anesthesiologist reports the appropriate anesthesia code separately. Do not append a modifier to 23675 to indicate anesthesia administration.

04Can 23675 be billed bilaterally with modifier 50?

Bilateral traumatic shoulder fracture-dislocations are exceedingly rare. Payers will flag modifier 50 on this code. If you have a true bilateral injury, use LT and RT on separate claim lines and attach robust documentation. Expect scrutiny.

05What modifier applies if the patient loses reduction and requires repeat manipulation in the global period?

Modifier 78 — unplanned return to the treatment setting for a procedure related to the original injury during the global period. Do not use modifier 79, which is reserved for unrelated procedures.

06How does the 90-day global affect billing for physical therapy referrals and post-reduction imaging?

The global bundles only the physician's own follow-up services. PT billed by a separate therapist is not part of the surgeon's global. Post-reduction imaging ordered during follow-up is separately billable by the radiology group; the surgeon cannot separately bill for interpreting those films unless no radiologist is reading them.

07When is modifier 22 appropriate for 23675?

Use modifier 22 when the reduction was substantially more complex than typical — for example, a chronically dislocated shoulder with an impacted neck fracture requiring prolonged manipulation effort. Document exactly why the work was significantly greater than standard, including time and difficulty encountered.

Sources & references

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

Mira Scribe

Mira's AI scribe captures dislocation direction, fracture location (surgical vs. anatomical neck), reduction technique, and pre/post neurovascular exam from dictation — then flags if the operative note omits the fracture component. That prevents the most common denial for 23675: a diagnosis code that supports only a dislocation, leaving the fracture-dislocation complexity unsubstantiated.

See how Mira captures CPT 23675 documentation