CPT 23625Surgery

Cltx gr hmrl tbrs fx w/mnpj

CPT 23625 covers closed treatment of a greater humeral tuberosity fracture with manipulation. This means a physician manually repositions a broken bone at the top of the shoulder without making any incisions or using surgery.

Showing rates for

National Average

Base Medicare rate

$388.48

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

4.1

PE RVU (NF)

7.1

MP RVU

0.81

Total RVU

12.01

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Verify place of service code accuracy: POS 22 (on-campus outpatient hospital) qualifies for non-facility rate of $388.48, while POS 24 (ambulatory surgical center) receives facility rate of $355.16
Impact: Incorrect POS coding results in $33.32 underpayment per case and potential audit flags
Document the specific manipulation technique, force applied, number of attempts, and post-reduction imaging confirmation of fracture alignment in operative note
Impact: Prevents downcoding to 23620 (without manipulation) which reimburses $144 less, protecting approximately 37% of revenue
Bill fluoroscopy separately with 77002 when used for guidance during manipulation, as it is not bundled with 23625
Impact: Captures additional $50-75 in reimbursement when fluoroscopic guidance is documented
Ensure anesthesia administration (conscious sedation) is separately documented with time-based codes 99151-99153 when performed by the operating physician
Impact: Recovers $75-150 in additional revenue for procedures requiring moderate sedation beyond local anesthesia
Appeal denials citing 'manipulation not documented' by submitting pre- and post-reduction radiographic images showing displacement correction with specific measurements
Impact: Successful appeals recover full $388.48 payment; success rate exceeds 70% with proper imaging documentation
For Medicare patients, verify the procedure meets the 10-day global period requirements and avoid billing separately for routine follow-up visits during this window
Impact: Prevents claim denials and recoupment demands averaging $200-400 per inappropriate follow-up visit

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 23625?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the difference between CPT 23620 and 23625?

CPT 23620 is for closed treatment without manipulation (simple immobilization of non-displaced fracture), while 23625 includes manipulation to reduce a displaced fracture. The key distinguisher is whether the physician actively repositions the fracture fragments through manual force. CPT 23625 reimburses approximately $240 more than 23620 due to the additional complexity and skill required for manipulation.

How much does Medicare pay for CPT 23625 in 2025?

Medicare pays $388.48 for CPT 23625 in non-facility settings (physician office) and $355.16 in facility settings (hospital outpatient or ASC) based on the 2025 national average. Actual payment varies by geographic location due to locality-specific adjustments to the Medicare Physician Fee Schedule.

Can I bill an E/M code with CPT 23625 on the same day?

Yes, you can bill an evaluation and management service with CPT 23625 on the same day using modifier 25, but only if the E/M represents a significant, separately identifiable service beyond the typical pre-procedure assessment. Documentation must clearly show the E/M involved substantial history, examination, or medical decision-making distinct from the fracture treatment decision.

What RVU value does CPT 23625 have?

CPT 23625 has a total RVU of 12.01 for 2025, consisting of 4.1 work RVUs, 7.1 practice expense RVUs (non-facility), and 0.81 malpractice RVUs. In facility settings, the practice expense RVU is 6.07, resulting in a lower total reimbursement.

Is fluoroscopy included in CPT 23625 or billed separately?

Fluoroscopy is not bundled with CPT 23625 and can be billed separately using CPT 77002 when used for intraoperative guidance during the manipulation. Documentation must specifically indicate fluoroscopy was used to guide reduction or confirm fracture alignment, including the number of images obtained and the medical necessity for imaging guidance.

What is the global period for CPT 23625?

CPT 23625 has a 10-day global period, meaning routine follow-up care within 10 days post-procedure is included in the procedure payment and cannot be billed separately. Any complications or unrelated services during this period may be billable with appropriate modifiers (24 for unrelated E/M, 78 for related return to procedure).

How do I document manipulation to justify CPT 23625 over 23620?

Documentation must include specific manipulation maneuvers performed (traction, rotation, abduction/adduction angles), the amount of force applied, number of reduction attempts, pre-reduction displacement measurements, and post-reduction imaging confirming improved alignment. Simply stating 'manipulation performed' is insufficient; describe the actual physical reduction technique used to reposition the greater tuberosity fragment.