CPT 23520Surgery

Cltx strnclav dislc w/o mnpj

CPT code 23520 covers the closed treatment of a sternoclavicular joint dislocation without manipulation—essentially stabilizing the collarbone where it connects to the breastbone without surgery or forceful repositioning.

Showing rates for

National Average

Base Medicare rate

$248.10

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

2.29

PE RVU (NF)

4.89

MP RVU

0.49

Total RVU

7.67

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Always append laterality modifiers (LT/RT) to avoid automatic denials—many payers now require these for all bilateral anatomical structures
Impact: Prevents automatic denials that delay payment by 15-30 days and require resubmission
Document clearly why manipulation was NOT performed—note stability of joint, patient tolerance, or clinical contraindications to differentiate from 23525 (with manipulation)
Impact: 23525 reimburses at $429.84 (facility), so improper upcoding triggers audits while proper documentation prevents downcoding disputes
Bill facility vs non-facility correctly based on place of service—ED visits default to facility rate ($246.48) vs office-based follow-up ($248.10)
Impact: Incorrect POS coding results in $1.62 variance and potential compliance flags for systematic errors
Separate E/M service with modifier 25 only when significant, separately identifiable evaluation beyond the procedure is documented (not routine pre-procedure assessment)
Impact: Legitimate modifier 25 adds $75-150 for appropriate level E/M, but overuse triggers payer audits with potential recoupment
For bilateral dislocations (rare), bill with modifier 50 or as two line items with LT/RT rather than units of 2
Impact: Proper bilateral coding yields 150% of single-side payment versus potential denial for incorrect unit reporting
Capture all 90-day global period services within this code—avoid separately billing routine follow-ups during this period
Impact: Prevents denials and recoupment of $50-100 per inappropriately billed follow-up visit

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 23520?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the 2025 Medicare reimbursement rate for CPT code 23520?

The 2025 Medicare national average reimbursement for CPT 23520 is $248.10 for non-facility settings and $246.48 for facility settings. The total RVU is 7.67 with a work RVU of 2.29.

What is the difference between CPT 23520 and 23525?

CPT 23520 is closed treatment of sternoclavicular dislocation WITHOUT manipulation, while 23525 includes manipulative reduction. The key documentation difference is whether the provider actively manipulated the joint to reduce the dislocation. Code 23525 reimburses significantly higher due to the additional procedural complexity.

Does CPT 23520 include follow-up visits?

Yes, CPT 23520 has a 90-day global period, meaning all routine postoperative care within 90 days is included in the reimbursement. Separately billing routine follow-ups during this period will result in denials unless complications or unrelated conditions are treated.

Can I bill an E/M code with CPT 23520 on the same date of service?

You can bill an E/M service with modifier 25 only if a significant, separately identifiable evaluation and management service was performed beyond the routine assessment needed for the procedure. Documentation must clearly support the distinct nature of the E/M service, such as evaluation of other injuries or complex medical decision-making.

Is CPT 23520 a facility or non-facility code?

CPT 23520 can be billed in both facility and non-facility settings, with different reimbursement rates. The facility rate ($246.48) applies when performed in hospitals or hospital outpatient departments. The non-facility rate ($248.10) applies when performed in physician offices or clinics that bear the practice expense.

What modifiers are required when billing CPT 23520?

Laterality modifiers LT (left) or RT (right) are required by most payers for CPT 23520 to specify which sternoclavicular joint was treated. Additional modifiers like 76 (repeat procedure), 54 (surgical care only), or 55 (postoperative care only) may apply based on specific circumstances.

What documentation is needed to support medical necessity for CPT 23520?

Required documentation includes diagnosis of sternoclavicular dislocation (with imaging confirmation when available), mechanism of injury, assessment of joint stability, explicit notation that manipulation was not performed and why, type of immobilization applied, laterality, and treatment plan. Clinical rationale for conservative closed treatment versus surgical intervention strengthens medical necessity.