CPT 23575Surgery

Cltx scap fx w/mnpj +-tractj

CPT code 23575 covers the non-surgical treatment of a broken shoulder blade (scapula) where the doctor manipulates the bone fragments back into proper position, with or without skeletal traction to hold the bones in place during healing.

Showing rates for

National Average

Base Medicare rate

$418.56

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

4.23

PE RVU (NF)

7.85

MP RVU

0.86

Total RVU

12.94

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

NCCI bundling edits

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Billing tips

Document pre-reduction and post-reduction imaging (X-rays or CT) in the operative note to establish medical necessity for manipulation versus simple immobilization
Impact: Prevents denials for lack of documentation; missing comparison imaging accounts for 30-40% of claim denials for this code
Bill in non-facility setting (office, ASC) when possible to capture the higher rate of $418.56 versus $386.54 facility rate - a difference of $32.02 per procedure
Impact: Generates 8.3% higher reimbursement in non-facility settings where appropriate
If skeletal traction is applied, document the specific insertion site, type of pin/wire, and duration of traction planned; consider whether separate traction codes are bundled or separately billable
Impact: Prevents unbundling denials and supports the '+/- traction' component of code descriptor
Clearly document the degree of fracture displacement pre-reduction and the specific manipulation maneuvers performed; generic 'fracture reduced' is insufficient
Impact: Strengthens medical necessity defense on appeal and reduces downcoding risk to 23570 (closed treatment without manipulation, paid $71.20 less)
For bilateral scapular fractures (rare), bill 23575 twice with RT and LT modifiers and modifier 50, or per payer preference for bilateral procedures
Impact: Bilateral cases typically reimburse at 150% of unilateral rate ($627.84 total) rather than 200%
Verify that anesthesia services (if general or conscious sedation used) are billed separately with appropriate anesthesia codes and not included in your procedure charge

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23575 in 2025?

The 2025 Medicare national average reimbursement for CPT 23575 is $418.56 in non-facility settings and $386.54 in facility settings, based on the CMS Physician Fee Schedule with a conversion factor of 32.3465.

What is the difference between CPT 23575 and 23570?

CPT 23575 includes manipulation (active repositioning of displaced fracture fragments), while 23570 is closed treatment without manipulation. The manipulation component adds significant complexity and reimbursement - 23575 pays approximately $90-100 more than 23570.

How many RVUs is CPT code 23575 worth?

CPT 23575 has 12.94 total RVUs for 2025, comprising 4.23 work RVUs, 7.85 non-facility practice expense RVUs (6.86 facility), and 0.86 malpractice RVUs.

Can CPT 23575 be billed with an E/M code on the same day?

Yes, but only if a significant, separately identifiable evaluation and management service was performed beyond the usual pre-procedure assessment. Append modifier 25 to the E/M code and document the distinct service with separate diagnosis or decision-making unrelated to the manipulation procedure itself.

Does CPT 23575 require general anesthesia?

No specific anesthesia type is required by the CPT code descriptor. The procedure may be performed under local anesthesia, regional block, conscious sedation, or general anesthesia depending on patient factors, fracture complexity, and physician preference. Document the anesthesia type used in your operative note.

What documentation is required to bill CPT 23575 instead of 23570?

You must document specific manipulation maneuvers performed, pre-reduction and post-reduction imaging showing fracture displacement and subsequent alignment, the force and techniques used to reduce the fracture, and clinical justification for why manipulation was medically necessary rather than simple immobilization.

Is skeletal traction separately billable with CPT 23575?

No, skeletal traction is included in CPT 23575 as indicated by the descriptor 'with or without skeletal traction.' Do not separately bill traction application codes when performed as part of scapular fracture manipulation. Document traction details to support the comprehensive service.