CPT 23540Surgery

Cltx acromclav dislc wo mnpj

CPT 23540 covers closed treatment of a dislocated acromioclavicular (AC) joint without manipulation. This is the shoulder separation injury where the collarbone separates from the shoulder blade, treated conservatively without surgical intervention or forceful repositioning.

Showing rates for

National Average

Base Medicare rate

$243.89

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

2.36

PE RVU (NF)

4.69

MP RVU

0.49

Total RVU

7.54

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

NCCI bundling edits

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Billing tips

Clearly document 'without manipulation' in the medical record to justify 23540 versus 23545 (with manipulation) which reimburses at $291.21
Impact: Prevents upcoding allegations while ensuring you don't leave $47.32 on the table if manipulation was actually performed
Bill same-day E/M with modifier 25 or 57 when comprehensive evaluation leads to treatment decision; document separate, significant service beyond procedure
Impact: Can add $75-200 to reimbursement depending on E/M level (99203-99205 or 99283-99285 in ED)
Verify laterality modifier (LT/RT) is included on claim submission; this is a CMS required field for shoulder procedures
Impact: Prevents automatic denial and resubmission delays that cost 15-30 days in payment cycle
Confirm Rockwood classification (Type I or II) is documented in clinical notes; higher grades may warrant 23545 or surgical codes
Impact: Supports medical necessity and proper code selection; Type III-VI injuries may qualify for higher reimbursement codes
Include CPT 73050 or 73060 (shoulder x-rays) on same claim when performed; these are separately billable diagnostic services
Impact: Adds $32-58 per study to total reimbursement and establishes imaging documentation of dislocation
Apply immobilization device codes (A4565 sling or L3960 shoulder orthosis) when supplied to patient
Impact: Additional $15-75 reimbursement for supplies provided during treatment encounter

Common denials

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Frequently asked questions

What is the Medicare reimbursement for CPT 23540 in 2025?

The 2025 Medicare national average reimbursement for CPT 23540 is $243.89 for non-facility settings and $242.28 for facility settings. The code carries 7.54 total RVUs (2.36 work RVU, 4.69 non-facility PE RVU, 0.49 MP RVU) based on the 2025 Medicare Physician Fee Schedule.

What is the difference between CPT 23540 and 23545?

CPT 23540 is for closed treatment of AC joint dislocation without manipulation, while 23545 includes manipulation to reduce the joint. The key documentation difference is whether manual reduction techniques were applied. Code 23545 reimburses at $291.21 compared to 23540's $243.89, a difference of $47.32.

Can I bill an E/M code with CPT 23540 on the same day?

Yes, you can bill a separate E/M service with modifier 25 or 57 if the evaluation was significant and separately identifiable from the treatment procedure. Modifier 57 is appropriate when the E/M resulted in the decision for treatment. Documentation must clearly support a separate service beyond the usual pre-procedure assessment.

What diagnosis codes support medical necessity for CPT 23540?

Primary diagnosis codes include S43.101A-S43.129A (acromioclavicular joint dislocation, initial encounter), with laterality specification. The diagnosis must indicate AC joint dislocation without associated fractures that would require different treatment codes. Type I or Type II AC separations (Rockwood classification) are most appropriate for conservative treatment.

Does CPT 23540 include follow-up visits?

Yes, CPT 23540 has a 90-day global period, meaning routine follow-up care related to the AC joint dislocation treatment is included in the reimbursement. Separate charges for follow-up visits during this period will be denied unless unrelated to the original injury or require modifier 24 for unrelated E/M services.

What modifiers are required when billing CPT 23540?

Laterality modifiers LT (left) or RT (right) are required by most payers for CPT 23540. Additional modifiers may include 57 (decision for surgery), 54 (surgical care only), 55 (postoperative care only), or 76 (repeat procedure) depending on the specific clinical circumstances and care arrangement.

Can CPT 23540 be billed bilaterally?

While bilateral AC joint dislocations are clinically rare, if they occur, you would bill 23540 twice with LT and RT modifiers, or use modifier 50 depending on payer preference. Most payers require separate line items with laterality modifiers rather than modifier 50 for shoulder procedures. Verify individual payer policies as bilateral payment may be reduced to 150% rather than 200% of the unilateral rate.