Optx scapular fx w/int fixj
CPT code 23585 covers the surgical repair of a broken shoulder blade (scapula) using internal fixation devices like plates, screws, or wires to hold the bone fragments in proper position while healing.
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
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
NCCI bundling edits
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Billing tips
Always append LT or RT modifier as scapular procedures require laterality designation
Impact: Prevents automatic denial; missing laterality results in 100% claim rejection requiring resubmission and payment delay
Document all hardware used (number of plates, screws, wires) and fracture complexity (comminution, displacement measurements) to support medical necessity
Impact: Reduces audit risk and supports modifier 22 usage which can increase payment by $192-$288 for unusually complex cases
Verify global period (90 days) to avoid unbundling errors with postoperative visits and related services
Impact: Prevents $50-$150 in denials for E/M services inappropriately billed during global period
Bill fluoroscopy (77002) separately if used for intraoperative guidance and documented as distinct from standard visualization
Impact: Additional $50-75 reimbursement when properly documented and medically necessary
Use modifier 22 with detailed operative note highlighting increased work when cases involve severe comminution, polytrauma, or obesity requiring extended surgical time
Impact: Requires submission of operative report; success rate 40-60% when well-documented, yielding additional $192-$288
Confirm procedure is not bundled with concurrent shoulder procedures; review NCCI edits before billing multiple codes
Impact: Prevents $300-$800 in bundled denials when billing with codes like 23472, 23615, or other shoulder ORIF procedures
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