CPT 23570Surgery

Cltx scapular fx w/o mnpj

CPT code 23570 covers the non-surgical treatment of a broken shoulder blade (scapula) without the doctor having to physically manipulate or reposition the bone. This typically involves stabilization with a sling or immobilizer and monitoring the healing process.

Showing rates for

National Average

Base Medicare rate

$241.95

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)

4.63

MP RVU

0.49

Total RVU

7.48

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

NCCI bundling edits

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Billing tips

Verify fracture displacement documentation - 23570 is only appropriate for non-displaced or minimally displaced fractures without manipulation; displaced fractures requiring manipulation should be coded to 23575
Impact: Incorrect code selection between 23570 and 23575 can result in $100+ payment difference and potential audit flags
Document the global period carefully - 23570 carries a 90-day global period; all routine follow-up care during this period is bundled and should not be separately billed
Impact: Separately billing E/M visits during the 90-day global can result in denials and recoupment of $50-150 per visit
Bill in the appropriate place of service - emergency department encounters should use facility rates ($250.36), while clinic follow-up encounters use non-facility rates ($241.95)
Impact: Incorrect POS coding can result in $8.41 payment variance and compliance issues
Include appropriate ICD-10 codes specifying scapular body, acromion, coracoid process, or glenoid cavity fracture location, laterality, encounter type (initial vs. subsequent), and whether displaced or non-displaced
Impact: Missing specificity in diagnosis coding leads to denial rates of 15-25% for fracture care claims
Ensure X-ray interpretation is separately documented and billed if performed by the treating physician (73050 for shoulder radiographs); do not assume imaging is bundled
Impact: Failing to bill separately for imaging interpretation loses approximately $25-45 in legitimate reimbursement per encounter
For initial emergency department encounters, confirm the fracture treatment is the primary service; if only minimal stabilization occurs with referral to orthopedics, an E/M code may be more appropriate than 23570

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Frequently asked questions

What is the 2025 Medicare reimbursement rate for CPT code 23570?

The 2025 Medicare national average reimbursement for CPT 23570 is $241.95 for non-facility settings and $250.36 for facility settings. The total RVU is 7.48 (Work RVU: 2.36, Non-Facility PE RVU: 4.63, Facility PE RVU: 4.89, MP RVU: 0.49) with a conversion factor of 32.3465.

What is the difference between CPT code 23570 and 23575?

CPT 23570 is for closed treatment of a scapular fracture without manipulation, meaning the fracture fragments are in acceptable alignment and require only immobilization. CPT 23575 is for closed treatment with manipulation, used when the physician must manually reposition displaced fracture fragments before immobilization.

Does CPT 23570 include follow-up visits?

Yes, CPT 23570 has a 90-day global period, which means all routine follow-up care related to the scapular fracture treatment is bundled into the initial code and cannot be separately billed. Only unrelated conditions or documented complications can be billed separately with appropriate modifiers during this period.

What diagnosis codes are appropriate for billing CPT 23570?

Appropriate ICD-10 codes include S42.101-S42.199 series for scapular fractures, specifying the anatomic location (body, acromion, coracoid, glenoid, neck), laterality (right/left), displacement status (displaced/non-displaced), and encounter type (initial encounter for closed fracture, typically seventh character 'A'). The non-displaced or minimally displaced status must align with the 'without manipulation' descriptor of 23570.

Can I bill an E/M code with CPT 23570 on the same date of service?

Generally no, unless the E/M service is for a significant, separately identifiable condition unrelated to the scapular fracture. If billing both, append modifier 25 to the E/M code with comprehensive documentation justifying the separate service. In emergency department settings, the decision to provide fracture care is typically included in the treatment code itself.

What modifiers are required when billing CPT 23570?

Laterality modifiers LT (left) or RT (right) are required for CPT 23570 to indicate which scapula was treated. Additional modifiers such as 54 (surgical care only), 55 (postoperative care only), or 76 (repeat procedure) may be appropriate depending on the specific circumstances of care delivery.

How long is the global period for CPT code 23570?

CPT 23570 has a 90-day global period. This means the code includes the initial treatment and all routine follow-up care for 90 days post-procedure. Billers should not separately report standard post-treatment visits during this period unless they meet criteria for exceptions with appropriate modifiers.