Fracture care · Shoulder

23680

Open surgical treatment of a shoulder dislocation combined with a fracture of the humeral neck, with internal fixation performed as needed.

Verified May 8, 2026 · 6 sources ↓

Medicare
$865.08
Total RVUs
25.9
Global, days
90
Region
Shoulder
Drawn from CMSAAPCMdclarityPayerprice

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 fracture location as humeral neck (not just 'proximal humerus' — payors distinguish neck from shaft and tuberosity fractures)
  • Document that dislocation was confirmed and addressed — imaging or intraoperative findings confirming glenohumeral dislocation must appear in the record
  • Identify fixation hardware used by type (plates, screws, IM nail, suture anchors) or explicitly state fixation was not performed and why
  • Describe the surgical approach by name — audit teams flag operative notes that say only 'standard deltopectoral approach' without further detail
  • Record neurovascular status of the extremity pre- and post-reduction, including axillary nerve assessment
  • If modifier 22 is appended, include a separate paragraph in the operative note quantifying additional time and complexity beyond the usual procedure

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 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 23680 covers open reduction of a glenohumeral dislocation occurring in conjunction with a fracture of the neck of the humerus, with or without internal fixation. This is a complex, high-acuity procedure — not a simple dislocation reduction. The surgeon must address both the bony injury and the joint instability through open exposure, fracture reduction, and fixation hardware when bone quality and fragment displacement require it.

The 90-day global period means the surgery, any same-day preoperative visit, and all routine postoperative care through day 90 are bundled into a single payment. Separately billing casting or strapping (29000–29590, 29105, 29240) applied at the time of surgery is an NCCI bundling violation — those codes are included in the fracture/dislocation care. If a cast is removed and replaced at a later encounter for a separate clinical reason, the casting code may be billed then.

Billing this code on the same day as a shoulder arthroscopy or a distinct open shoulder procedure requires careful modifier application. Modifier 51 applies to the lower-valued secondary procedure. Modifier 22 is appropriate when operative complexity — severe comminution, soft-tissue interposition, revision after failed closed treatment — substantially increases operative time and effort, but it must be supported by a detailed operative note narrative, not just a checkbox.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU12.82
Practice expense RVU10.35
Malpractice RVU2.73
Total RVU25.9
Medicare national rate$865.08
Global period90 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

SettingMedicare rate (national)
Office (PFS non-facility)
Procedure performed in physician's office
$865.08
HOPD (APC 5115)
Hospital outpatient department
$13,116.76
ASC (PI J8)
Ambulatory surgical center (freestanding)
$9,076.09

Common denial reasons

The recurring reasons claims for CPT 23680 get rejected.

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

  • Casting or strapping code (29000–29590, 29105, 29240) billed same-day — NCCI bundles these into 23680
  • Diagnosis code does not specify dislocation concurrent with fracture — a fracture-only or dislocation-only ICD-10 code will not support 23680
  • Modifier 22 appended without supporting documentation of increased complexity in the operative note
  • Global period violation — routine postoperative office visits billed within 90 days without modifier 24 or 25
  • Laterality not specified — missing LT or RT modifier triggers claim edits with many commercial payers

Frequently asked questions

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

01What separates 23680 from other proximal humerus fracture codes like 23615 or 23616?
23680 is specific to a dislocation combined with a humeral neck fracture. Codes 23615 and 23616 address proximal humeral fractures without concurrent dislocation. If the glenohumeral joint is dislocated at the time of surgery, 23680 is the correct code — not 23615 or 23616.
02Can I bill a separate casting code when I apply a sling or immobilizer after 23680?
No. NCCI bundles casting and strapping codes (29000–29590, 29105, 29240) into shoulder fracture/dislocation codes including 23680. The initial immobilization applied at surgery is included in the procedure. Only a separate later cast change, at a distinct encounter, may be billed separately.
03Does the 90-day global apply even if the patient is discharged to a different provider for follow-up?
The global period follows the billing surgeon. If a different physician provides the postoperative care, the operating surgeon can use modifier 54 to indicate surgical care only, and the follow-up physician bills modifier 55. Both modifiers split the global payment proportionally. Without that split, the operating surgeon's payment already includes the full 90-day package.
04When is modifier 22 justified for 23680?
Modifier 22 is supported when operative work is substantially greater than typical — examples include severe comminution requiring extended fixation, significant soft-tissue interposition requiring dissection, or revision after a failed closed attempt resulting in prolonged operative time. The operative note must document the specific factors that increased difficulty, not just note that the case 'was complex.'
05If I return the patient to the OR during the 90-day global for hardware failure, which modifier applies?
Modifier 78 applies to an unplanned return to the OR for a procedure related to the original surgery during the postoperative period — hardware failure is related. Modifier 79 is for an unrelated procedure. Do not invert these; payers audit modifier 78 vs. 79 usage closely.
06Is prior authorization typically required for 23680?
Most commercial payers require prior authorization for open shoulder procedures including 23680. Authorization requirements vary by payer. Obtain auth before surgery and confirm it covers the specific fracture-dislocation indication, not just a generic shoulder open procedure, to avoid post-service denials.

Sources & references

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

  1. 01CMS Physician Fee Schedule 2026
  2. 02
    cms.gov
    https://www.cms.gov/files/document/04-chapter4-ncci-medicare-policy-manual-2025finalcleanpdf.pdf
  3. 03
    aapc.com
    https://www.aapc.com/codes/coding-newsletters/my-orthopedic-coding-alert/new-ncci-edits-make-their-debut-know-when-you-can-collect-for-casting-article?srsltid=AfmBOoqPIc-7SHJ82g178IHJ4hr1gQICWQ4Y9YoE3gvZy5ImkWQ-2yys
  4. 04
    mdclarity.com
    https://www.mdclarity.com/cpt-code/23680
  5. 05
    payerprice.com
    https://payerprice.com/rates/23680-CPT-fee-schedule
  6. 06
    aapc.com
    https://www.aapc.com/codes/cpt-codes/23680

Mira AI Scribe

Mira's AI scribe captures the fracture site (humeral neck), dislocation confirmation, surgical approach, fixation hardware type and quantity, and pre/post neurovascular findings directly from dictation. This prevents the most common 23680 denial: a diagnosis or operative note that documents a fracture or a dislocation but not both, which disqualifies the code entirely.

See how Mira captures CPT 23680 documentation

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Closed treatment of a distal phalangeal fracture of a finger or thumb, performed with manipulation to restore alignment.
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