CPT 23605Surgery

Cltx prx hmrl fx mnpj+-tract

CPT 23605 covers closed treatment of a broken upper arm bone (proximal humerus fracture) near the shoulder without surgery, using manipulation to realign the bone fragments with or without skeletal traction.

Showing rates for

National Average

Base Medicare rate

$476.14

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

5.06

PE RVU (NF)

8.63

MP RVU

1.03

Total RVU

14.72

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

NCCI bundling edits

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Billing tips

Verify place of service code accuracy - bill POS 22 (on-campus outpatient hospital) for facility rate or POS 11 (office) for non-facility rate
Impact: $44.31 difference between settings; incorrect POS coding leads to $44.31 underpayment or overpayment subject to recoupment
Document and separately bill conscious sedation services when performed (99151-99153 or 99155-99157) as these are not bundled with 23605
Impact: Additional $75-150 in reimbursement for moderate sedation services typically required for manipulation
Bill for skeletal traction application on same date only when medically necessary and documented; traction codes may be separately reportable depending on payer
Impact: Some payers allow separate payment for 20650 (insertion of wire/pin with skeletal traction) worth approximately $200-300
Use correct laterality modifier (LT/RT) on initial submission - bilateral procedures are extremely rare and require 50 modifier with documentation
Impact: Missing laterality causes immediate denial requiring resubmission; bilateral coding with 50 modifier yields 150% payment ($714.21) but requires clear documentation
Verify global period (90 days) and avoid billing separately for routine follow-up E/M visits during this window unless unrelated problem
Impact: Inappropriate E/M billing during global period results in $100-300 denials per visit and potential audit flags
When manipulation fails and requires subsequent open reduction (23615/23616), append modifier 58 or 78 depending on whether planned or unplanned
Proper staged procedure coding with modifier 58 allows full payment for subsequent procedure; modifier 78 reduces payment to intraoperative portion only

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Frequently asked questions

What is the Medicare reimbursement for CPT 23605 in 2025?

Medicare pays $476.14 for CPT 23605 in non-facility settings and $431.83 in facility settings under the 2025 Medicare Physician Fee Schedule, based on 14.72 total RVUs and a conversion factor of 32.3465.

What is the difference between CPT 23605 and 23600?

CPT 23605 includes manipulation to realign displaced fracture fragments, while CPT 23600 is for closed treatment without manipulation. Code 23605 requires documentation of active reduction maneuvers and displaced fracture requiring realignment, and reimburses approximately $200-250 more than 23600.

Can CPT 23605 be billed with an E/M code on the same date?

Yes, an E/M service can be billed with modifier 25 on the same date if a separately identifiable evaluation was performed and documented. The E/M must be distinct from the typical pre-procedure assessment and address different medical decision-making beyond deciding to perform the manipulation.

What is the global period for CPT 23605?

CPT 23605 has a 90-day global surgical period, meaning routine postoperative visits, normal post-procedure care, and complications not requiring return to operating room are included in the base payment and should not be billed separately.

Does CPT 23605 require a modifier for left or right side?

Yes, CPT 23605 requires either modifier LT (left) or RT (right) to indicate laterality. This is mandatory for claim processing, and missing the laterality modifier will result in immediate claim denial by most payers including Medicare.

How many RVUs is CPT code 23605 worth in 2025?

CPT 23605 has 14.72 total RVUs in 2025, consisting of 5.06 work RVUs, 8.63 non-facility practice expense RVUs (7.26 facility), and 1.03 malpractice RVUs, making it a moderate-intensity orthopedic procedure code.

Can conscious sedation be billed separately with CPT 23605?

Yes, moderate conscious sedation codes (99151-99157) can be billed separately with CPT 23605 as sedation is not bundled into the base procedure code. Documentation must support medical necessity and include time-based elements for appropriate sedation code selection.