Cltx prox humrl fx w/o mnpj
CPT 23600 covers the closed treatment of a broken upper arm bone near the shoulder without manipulation, meaning the doctor treats the fracture without surgically realigning the bone fragments.
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
Verify place of service code carefully: POS 22 (outpatient hospital) triggers facility rate of $324.76 versus POS 11 (office) for non-facility rate of $342.55
Impact: Incorrect POS coding results in $17.79 reimbursement difference and potential audit flags
Document why manipulation was NOT required by noting fracture displacement measurements and alignment parameters in operative note
Impact: Prevents downcoding or denial when payer questions why 23605 (with manipulation, paying $175+ more) was not performed
Bill initial fracture care on date of service, not date of injury; use injury date in Occurrence Code 11 or Box 11
Impact: Ensures proper timely filing and prevents denials for services rendered outside accident date parameters
Include always the laterality modifier (LT or RT) on first submission to avoid automatic denials and reprocessing delays
Impact: Missing laterality causes 15-30 day payment delays and potential denial requiring corrected claim submission
Capture and bill appropriate E/M code separately only if significant separately identifiable service performed on same date with modifier 25
Impact: Additional $75-$150 revenue for complex evaluation when properly documented as distinct from fracture care decision-making
Submit radiographic imaging (73060, 73030) separately as radiology services are not bundled into fracture care codes
Impact: Additional $40-$80 in legitimate reimbursement often missed when providers assume imaging is included
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