CPT 23505Surgery

Cltx clavicular fx w/mnpj

CPT 23505 covers the closed treatment of a broken collarbone (clavicle fracture) with manipulation, meaning the physician manually repositions the broken bone pieces without making an incision.

Showing rates for

National Average

Base Medicare rate

$368.10

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

3.83

PE RVU (NF)

6.76

MP RVU

0.79

Total RVU

11.38

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

NCCI bundling edits

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Billing tips

Document the manipulation explicitly with before/after descriptions of fracture alignment and the force/technique used
Impact: Inadequate documentation leads to downcoding to 23500 (without manipulation), resulting in $100+ reimbursement loss
Always append laterality modifier (LT or RT) as this is a bilateral code requiring side designation
Impact: Missing laterality causes immediate denial; resubmission delays payment by 30-45 days on average
Bill in non-facility setting when performed in clinic or office to capture higher rate
Impact: Non-facility payment is $368.10 vs $341.58 facility, a difference of $26.52 (7.8% higher)
Verify the 90-day global period is communicated to patient and properly tracked for bundled follow-up visits
Impact: Attempting to bill E/M codes during global period results in denials unless modifier 24 is appropriately applied for unrelated issues
When performed in ED, ensure place of service code 23 is used and facility fee is billed separately by hospital
Impact: Incorrect POS code can trigger $26.52 underpayment if non-facility rate is incorrectly applied to facility setting
Consider diagnostic imaging documentation requirements; X-rays must be separately billed (73000-73010) and are not included in 23505
Impact: Failure to bill appropriate imaging separately can result in $40-80 lost revenue per encounter

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Frequently asked questions

What is the difference between CPT 23500 and 23505?

CPT 23500 covers closed treatment of clavicle fracture without manipulation (simple immobilization only), while 23505 includes manipulation - the physician manually repositions displaced fracture fragments. The manipulation component adds approximately $100 to reimbursement but requires specific documentation of the reduction technique and alignment improvement.

How much does Medicare pay for CPT code 23505 in 2025?

Medicare pays $368.10 for CPT 23505 in non-facility settings and $341.58 in facility settings based on the 2025 national average. Actual payment varies by geographic locality due to GPCI adjustments. The code has 11.38 total RVUs (3.83 work RVU).

What is the global period for CPT 23505?

CPT 23505 has a 90-day global period, meaning all routine follow-up care related to the clavicle fracture treatment is included in the initial payment. Separate E/M services during this period are not separately billable unless unrelated to the fracture (requires modifier 24) or involve a significant separately identifiable service on the day of the procedure (requires modifier 25).

Can nurse practitioners or physician assistants bill CPT 23505?

Yes, qualified nurse practitioners and physician assistants may perform and bill CPT 23505 under appropriate supervision according to state scope of practice laws. Medicare typically reimburses at 85% of the physician fee schedule when NPPs bill under their own NPI. Use modifier AS to indicate the service was performed by a non-physician practitioner.

What documentation is required to support CPT 23505 billing?

Required documentation includes: fracture description with displacement details, pre-manipulation alignment assessment, specific manipulation technique and force applied, post-manipulation assessment showing alignment improvement, type of immobilization applied, laterality designation, and medical necessity justification. Without explicit manipulation documentation, payers will downcode to 23500.

Can you bill an E/M visit with CPT 23505 on the same day?

Yes, but only with modifier 25 appended to the E/M code and documentation of a separately identifiable evaluation and management service beyond the assessment included in the fracture care. The E/M must address evaluation elements not inherent to deciding to perform the manipulation, such as assessment of multiple injuries or unrelated medical conditions.

Is imaging included in CPT 23505 reimbursement?

No, diagnostic imaging (X-rays) is billed separately using codes 73000-73010 for clavicle imaging. CPT 23505 covers only the manipulation and immobilization procedure itself. Both pre-manipulation and post-manipulation X-rays should be billed separately when performed and documented as medically necessary.