CPT 23515Surgery

Optx clavicular fx w/int fix

CPT code 23515 covers surgical repair of a broken collarbone (clavicle fracture) using internal fixation devices like plates, screws, or pins to hold the bone fragments in proper position while healing.

Showing rates for

National Average

Base Medicare rate

$715.18

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

9.69

PE RVU (NF)

10.51

MP RVU

1.91

Total RVU

22.11

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

NCCI bundling edits

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Billing tips

Always append laterality modifier (LT or RT) on initial claim submission - this is the most common reason for immediate denial
Impact: Prevents automatic denial and 2-4 week payment delay; required for all claims
Document fracture displacement, comminution pattern, and specific clinical indication for ORIF rather than conservative treatment to justify medical necessity
Impact: Reduces denial risk by 60-70%; many payers require documentation of >2cm shortening or specific displacement criteria
Separately bill for pre-operative radiographs under appropriate radiology codes if performed and documented by your practice
Impact: Additional $40-80 revenue per case; commonly missed ancillary revenue
Use modifier 22 with detailed operative report for cases requiring >90 minutes operative time or extensive comminution with multiple fragments requiring individual fixation
Impact: Can increase reimbursement by $140-360 (20-50% increase) when properly documented and justified
Do not separately bill for hardware (plates, screws) as these are included in the facility fee; surgeon fee is technical service only
Impact: Prevents unbundling denials and potential audit flags; hardware cost recovery is facility responsibility
For ASC settings, verify the code is on the approved ASC list and ensure patient meets outpatient surgical criteria to avoid non-covered setting denials
Impact: Prevents 100% denial; some payers require inpatient setting for certain comorbidities or complex fracture patterns

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23515 in 2025?

The 2025 Medicare national average reimbursement for CPT 23515 is $715.18 for both facility and non-facility settings. This is based on 22.11 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality.

Does CPT 23515 include hardware removal or is that billed separately?

Hardware removal is NOT included in CPT 23515 and is billed separately using CPT 23920 (removal of bone fixation device). However, if removal occurs within the 90-day global period, modifier 78 must be appended and only the intraoperative portion is reimbursed. Routine hardware removal typically occurs 12-18 months post-op, outside the global period.

What modifiers are required when billing CPT code 23515?

Laterality modifiers LT (left) or RT (right) are required for all claims. Additional modifiers may include 22 (increased procedural services), 78 (return to OR in global period), 79 (unrelated procedure in global period), 62 (co-surgeons), or AS (assistant surgeon) depending on specific circumstances.

Can CPT 23515 be billed bilaterally with modifier 50?

While technically possible for bilateral clavicle fractures, this scenario is extremely rare. If it occurs, use modifier 50 or bill as two line items with LT and RT modifiers (payer preference varies). Documentation must clearly support bilateral surgical necessity and expect enhanced review for medical necessity.

What is the global period for CPT 23515?

CPT 23515 has a 90-day global surgical period. This includes pre-operative evaluation on the day of or day before surgery, the surgical procedure itself, and all routine post-operative care for 90 days. Complications or unrelated services may be billed separately with appropriate modifiers.

How many RVUs is CPT code 23515 worth?

CPT 23515 has 22.11 total RVUs for 2025, consisting of 9.69 work RVUs, 10.51 practice expense RVUs (both facility and non-facility), and 1.91 malpractice RVUs. This represents a major surgical procedure requiring significant physician work and resources.

What diagnosis codes support medical necessity for CPT 23515?

Primary diagnosis codes include S42.021A-S42.026A (displaced clavicle fractures, initial encounter), S42.031A-S42.036A (displaced midshaft clavicle fractures), and similar codes for comminuted or segmental fractures. The diagnosis must support surgical intervention necessity, typically requiring documentation of >2cm displacement, comminution, or other criteria contraindicating conservative management.