CPT 23500Surgery

Cltx clavicular fx w/o mnpj

CPT code 23500 covers the closed treatment of a broken collarbone (clavicle fracture) without manipulation, meaning the doctor stabilizes the fracture without surgically realigning the bone fragments.

Showing rates for

National Average

Base Medicare rate

$230.63

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

2.21

PE RVU (NF)

4.45

MP RVU

0.47

Total RVU

7.13

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Verify facility versus non-facility setting before billing - this significantly affects reimbursement for 23500
Impact: Facility setting pays $236.13 versus non-facility $230.63, a difference of $5.50 per claim based on 2025 Medicare rates
Document the decision-making process for non-manipulation clearly in the medical record, including fracture displacement measurements and rationale for conservative treatment
Impact: Prevents downcoding to E/M only or denials questioning medical necessity; can protect the full $230.63-236.13 reimbursement
Bill 23500 only once regardless of the number of office visits for application of immobilization device; global period is 90 days
Impact: Follow-up visits within 90 days are included in the global surgical package and cannot be separately billed, avoiding $150-200 in denied E/M claims
When performed in ED, coordinate billing between ED physicians and orthopedic consultants to avoid duplicate billing for same service
Impact: Prevents denials for duplicate services; typically ED bills E/M with modifier 57 and orthopedist bills 23500, preserving both claims
Use laterality modifiers (RT/LT) on every claim even though not explicitly required by Medicare
Impact: Prevents processing delays and appeals with commercial payers; reduces denial rate by 15-20% based on industry data
Separately bill for initial x-rays (73060) when performed and documented by the treating provider
Impact: Additional $40-80 reimbursement when x-rays are properly documented as distinct from the fracture treatment

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 23500 in 2025?

The 2025 Medicare national average reimbursement for CPT 23500 is $230.63 in non-facility settings and $236.13 in facility settings. These rates are based on a total RVU of 7.13 and the 2025 conversion factor of 32.3465.

What is the difference between CPT 23500 and 23505?

CPT 23500 is for closed treatment of a clavicular fracture without manipulation, while 23505 is for closed treatment with manipulation. Code 23505 requires active reduction of fracture fragments and has higher reimbursement due to the additional work involved in manipulating the fracture into better alignment.

Does CPT 23500 include follow-up visits?

Yes, CPT 23500 has a 90-day global surgical period, meaning all routine follow-up care related to the fracture treatment is included in the reimbursement and cannot be billed separately. Only visits for unrelated problems or complications beyond normal recovery can be billed with appropriate modifiers.

Can I bill an E/M code with CPT 23500 on the same date of service?

Generally no, unless a significant, separately identifiable evaluation and management service was performed beyond the typical assessment included in deciding to perform closed treatment. If billing both, append modifier 25 to the E/M code and ensure documentation clearly supports the distinct nature of the additional service.

What RVU value does CPT 23500 have?

CPT 23500 has a total RVU of 7.13 for 2025, consisting of 2.21 work RVU, 4.45 non-facility practice expense RVU (4.62 facility), and 0.47 malpractice RVU. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 2024.

Do I need to use a modifier for left versus right clavicle with CPT 23500?

While not explicitly required by Medicare for payment, using anatomical modifiers LT (left) or RT (right) is considered best practice and is required by many commercial payers. These modifiers provide specificity and prevent processing delays or denials, especially in cases where bilateral injuries might occur.

Can CPT 23500 be billed by a nurse practitioner or physician assistant?

Yes, nurse practitioners and physician assistants can bill CPT 23500 within their scope of practice and according to state regulations. Medicare reimburses NPs and PAs at 85% of the physician fee schedule amount. Appropriate supervision requirements must be met based on practice setting and state law.