CPT 23650Surgery

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CPT code 23650 covers the treatment of a dislocated shoulder using manual manipulation to put the joint back in place, performed without anesthesia. This is the closed reduction procedure commonly performed in emergency departments when a patient presents with an acute shoulder dislocation.

Showing rates for

National Average

Base Medicare rate

$341.26

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

3.53

PE RVU (NF)

6.3

MP RVU

0.72

Total RVU

10.55

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

NCCI bundling edits

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Billing tips

Distinguish between 23650 (without anesthesia) and 23655 (with anesthesia requiring anesthesia services). If procedural sedation is administered, you must bill 23655 instead.
Impact: Using correct code prevents denials and recoupment; 23655 has higher RVU value (4.50 work RVUs vs 3.53) resulting in approximately $40-50 higher reimbursement
Always append LT or RT modifier to indicate laterality. Medicare and most commercial payers require laterality modifiers for all bilateral procedures.
Impact: Missing laterality modifier results in claim rejection or denial, delaying payment by 15-30 days on average
Bill for pre- and post-reduction X-rays separately using appropriate radiology codes (73030, 73060). These are not bundled with 23650.
Impact: Recovers additional $50-120 per encounter depending on views obtained and payer fee schedules
Document all reduction attempts, specific technique used, time spent, pre/post neurovascular examination, and medical necessity for performing without anesthesia in the procedure note.
Impact: Comprehensive documentation reduces audit risk and supports medical necessity; prevents downcoding or denials worth the full $341.26 payment
For facility billing, verify place of service code matches actual location (22 for outpatient hospital, 23 for emergency department). Medicare pays different rates based on POS.
Impact: Correct POS coding ensures proper payment; incorrect POS may trigger $33.64 payment differential between facility and non-facility rates
When multiple reduction attempts are required on the same day, use modifier 76 only if clearly documented as separate encounters with re-dislocation between attempts.

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Frequently asked questions

What is the difference between CPT 23650 and 23655?

CPT 23650 is for closed treatment of shoulder dislocation with manipulation performed without anesthesia, while 23655 is used when the procedure requires anesthesia services (procedural sedation or general anesthesia). The key distinction is whether separate anesthesia administration and monitoring is necessary for the reduction procedure. 23655 has higher work RVUs (4.50 vs 3.53) and reimburses approximately $40-50 more than 23650.

How much does Medicare pay for CPT code 23650 in 2025?

For 2025, Medicare pays $341.26 for CPT 23650 in non-facility settings (office-based) and $307.62 in facility settings (hospital outpatient or ASC). The code has 10.55 total RVUs (3.53 work RVU, 6.3 non-facility PE RVU, 5.26 facility PE RVU, and 0.72 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Can I bill for X-rays separately with CPT 23650?

Yes, pre-reduction and post-reduction X-rays are separately billable and not bundled with CPT 23650. Typically you would bill CPT 73060 for shoulder X-rays (2-3 views) or 73030 for a single view, depending on what imaging was obtained. The professional and technical components may be billed separately based on practice setting.

What modifier is required when billing CPT 23650?

Laterality modifiers LT (left side) or RT (right side) are required when billing CPT 23650 to indicate which shoulder was treated. Claims submitted without laterality modifiers will typically be rejected or denied by Medicare and most commercial payers. Additional modifiers like 76 (repeat procedure by same physician) may be appropriate in specific circumstances.

Can nurse practitioners and physician assistants bill CPT 23650?

Yes, qualified nurse practitioners and physician assistants can perform and bill CPT 23650 within their scope of practice and state licensure requirements. They may bill under their own NPI number or incident-to a physician depending on the setting and supervision arrangements. Medicare reimburses NPPs at 85% of the physician fee schedule when billing under their own NPI.

What documentation is required to support medical necessity for CPT 23650?

Required documentation includes pre-reduction X-rays confirming dislocation, detailed procedure note describing the reduction technique used, number of attempts, neurovascular examination before and after reduction, post-reduction imaging confirming successful relocation, and explanation of why the procedure was performed without anesthesia. Time spent and specific clinical findings should be clearly documented.

Can CPT 23650 be billed twice on the same day for re-dislocation?

Yes, if a shoulder re-dislocates and requires a second reduction on the same day, you can bill 23650 twice using modifier 76 (repeat procedure by same physician) or 77 (repeat procedure by different physician). Documentation must clearly demonstrate two separate dislocation events with distinct reduction procedures, including time stamps and clinical notes supporting the medical necessity of the repeat reduction.