CPT 23525Surgery

Cltx strnclav dislc w/mnpj

CPT code 23525 covers the treatment of a dislocated sternoclavicular joint (where the collarbone meets the breastbone) using closed manipulation without surgery. The provider manually repositions the joint back into its proper alignment.

Showing rates for

National Average

Base Medicare rate

$406.60

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

3.79

PE RVU (NF)

7.99

MP RVU

0.79

Total RVU

12.57

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

NCCI bundling edits

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Billing tips

Document whether manipulation was performed under general anesthesia, conscious sedation, or local anesthesia, as this affects medical necessity justification and potential use of modifier 47
Impact: Proper anesthesia documentation can support modifier 47 use, adding approximately $20-40 to reimbursement and preventing denials for lack of medical necessity
Capture and bill separately for any imaging performed for post-reduction confirmation (typically 71110 or 71100 for chest x-ray with sternoclavicular views)
Impact: Adds $45-75 in additional revenue per encounter; commonly overlooked ancillary service
For emergency department settings, verify facility vs. non-facility determination as the $35.26 difference ($406.60 vs $371.34) depends on place of service code
Impact: Incorrect POS code 22 instead of 23 or vice versa can result in $35.26 underpayment per claim
Bill in the global period only once; re-dislocations within 90 days require modifier 76 or 77 and strong documentation of medical necessity
Impact: Prevents denials for duplicate services; recurrent dislocations may be reduced by 50% or denied entirely without proper modifier and documentation
When performed with E/M service on the same day, append modifier 25 to the E/M only if separately identifiable and documented beyond the decision for manipulation
Impact: Supports additional $100-200 in E/M revenue, but improper use is a common audit trigger resulting in E/M recoupment
For bilateral sternoclavicular dislocations (rare), bill 23525 twice with RT and LT modifiers rather than modifier 50, as the bilateral modifier is not applicable to this code

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Frequently asked questions

What is the Medicare reimbursement for CPT 23525 in 2025?

The 2025 Medicare national average reimbursement for CPT 23525 is $406.60 for non-facility settings and $371.34 for facility settings. These rates are based on the CMS Physician Fee Schedule with a conversion factor of 32.3465.

What is the difference between CPT 23525 and 23520?

CPT 23520 covers closed treatment of sternoclavicular dislocation WITHOUT manipulation, while 23525 includes manipulation. Code 23525 requires active manual reduction of the displaced joint and has higher RVUs (12.57 vs. lower for 23520) reflecting the additional work involved.

Can CPT 23525 be billed with an E/M code on the same day?

Yes, but only if the E/M service is separately identifiable and documented beyond the decision for manipulation. Append modifier 25 to the E/M code and ensure documentation clearly shows evaluation distinct from the manipulation procedure itself, such as assessment of other injuries or medical conditions.

How many RVUs is CPT code 23525 worth?

CPT 23525 has a total RVU value of 12.57, consisting of 3.79 work RVUs, 7.99 practice expense RVUs (non-facility), and 0.79 malpractice RVUs. The facility setting has lower PE RVUs at 6.90.

What type of anesthesia is required for billing CPT 23525?

CPT 23525 does not mandate a specific type of anesthesia, but manipulation typically requires conscious sedation or general anesthesia due to pain and muscle spasm. Documentation should specify the anesthesia type used. If the surgeon administers regional or general anesthesia, modifier 47 may be appropriate.

Is CPT 23525 subject to a global period?

Yes, CPT 23525 has a 90-day global period. All routine post-operative care within 90 days is included in the reimbursement. Any manipulation repeated within this period requires modifier 76 and documentation of medical necessity, such as re-dislocation from new trauma.

What imaging is needed to support billing CPT 23525?

Both pre-reduction imaging confirming sternoclavicular dislocation and post-reduction imaging documenting successful joint reduction are essential. Typically, this includes dedicated sternoclavicular views, chest x-rays with oblique views, or CT scans. Without documented imaging confirmation, claims face high risk of medical necessity denials.