CPT 23545Surgery

Cltx acromclav dislc w/mnpj

CPT 23545 covers the treatment of a separated shoulder (acromioclavicular or AC joint dislocation) using manipulation techniques without surgery. The provider manually repositions the displaced collarbone where it meets the shoulder blade.

Showing rates for

National Average

Base Medicare rate

$369.72

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

3.43

PE RVU (NF)

7.28

MP RVU

0.72

Total RVU

11.43

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

NCCI bundling edits

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Billing tips

Document Rockwood classification and specific manipulation technique used (anterior-to-posterior pressure, superior-to-inferior reduction) to support complexity
Impact: Prevents downcoding to evaluation codes; proper documentation supports full $369.72 vs. $184.20 for E/M with procedure denial
Bill in non-facility setting when performed in clinic with own equipment to capture $38.49 higher reimbursement ($369.72 vs $331.23)
Impact: Direct revenue increase of 11.6% when performed in owned/controlled space versus hospital facility
Separately code anesthesia (99152-99153 for moderate sedation) if you provide sedation and document time exceeding 5 minutes beyond procedure time
Impact: Additional $112-168 revenue for first 15-30 minutes of sedation when properly documented with independent observer
Use time-based documentation for procedures requiring extended manipulation beyond typical 15-20 minutes to support medical necessity against denial
Impact: Reduces appeal rate by 40-60% when complex reductions are questioned by payers expecting simpler sling-only treatment
Verify patient has not had previous AC joint surgery on same side; prior surgery requires different code (23552) with different RVU structure
Impact: Prevents claim rejection and 30-60 day payment delay; 23552 pays approximately 40% more at $517.28 for open treatment
Include post-reduction imaging (X-ray) documentation showing successful reduction or continued subluxation requiring alternative treatment
Impact: Supports medical necessity and demonstrates appropriate standard of care; imaging codes (73050) add $38-52 per view when properly documented

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23545 in 2025?

The 2025 Medicare national average reimbursement for CPT 23545 is $369.72 in non-facility settings and $331.23 in facility settings. These rates are based on 11.43 total RVUs (3.43 work RVU, 7.28/6.09 PE RVU, 0.72 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 23545 be billed with an E/M code on the same day?

Yes, but you must append modifier 25 to the E/M code and document a significant, separately identifiable evaluation and management service beyond the typical pre-procedure assessment. The E/M documentation must address issues beyond the decision to perform the manipulation, such as evaluation of other injuries or medical conditions requiring separate work.

What is the difference between CPT 23545 and 23550?

CPT 23545 is for closed treatment with manipulation (manual reduction without incision), while CPT 23550 is for open treatment requiring surgical incision. The choice depends on injury severity, chronicity, and whether surgical exposure is needed. CPT 23550 has higher RVUs and reimburses approximately $517 versus $370 for 23545.

Does CPT 23545 require anesthesia or sedation to be billable?

While not absolutely required by CPT definition, manipulation typically requires anesthesia or procedural sedation to relax muscles and achieve reduction. Documentation of anesthesia/sedation strengthens medical necessity. If you provide moderate sedation, you can separately bill 99152-99153 when criteria are met and time is documented.

What is the global period for CPT 23545?

CPT 23545 has a 10-day global period, meaning routine post-operative care for 10 days following the procedure is included in the reimbursement. Separate E/M services during this period require modifier 24 and documentation of an unrelated problem or complication beyond normal recovery.

How do I bill CPT 23545 if the manipulation fails?

If manipulation is attempted but unsuccessful, you can still bill CPT 23545 with documentation of the attempt, technique used, and reason for failure. If a second manipulation attempt is made in the same session, append modifier 76 (expect 50% reduction). If the patient later requires open surgery, that would be coded separately with 23550-23552.

What diagnosis codes support medical necessity for CPT 23545?

Primary diagnosis codes include S43.10xA-S43.15xA (unspecified AC joint sprain, initial encounter), S43.11xA-S43.12xA (AC subluxation/dislocation), and S43.13xA (AC joint sprain by severity). The diagnosis must indicate acute injury requiring manipulation; chronic conditions typically do not support this code and may require reconstruction codes instead.