CPT 23655Surgery

Cltx sho dslc w/mnpj w/anes

CPT 23655 covers the treatment of a dislocated shoulder where the physician manipulates the joint back into place while the patient is under anesthesia. This procedure is used when a shoulder dislocation cannot be reduced with simple manual techniques while the patient is awake.

Showing rates for

National Average

Base Medicare rate

$410.48

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

4.76

PE RVU (NF)

6.96

MP RVU

0.97

Total RVU

12.69

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

NCCI bundling edits

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Billing tips

Always append laterality modifier (LT or RT) on the primary claim line - this is mandatory for CPT 23655
Impact: Prevents automatic denial; claims without laterality are rejected at clearinghouse or payer level, delaying payment by 15-30 days
Document the medical necessity for anesthesia administration, including failed awake reduction attempts or clinical contraindications to awake manipulation
Impact: Justifies the higher complexity code versus 23650 (without anesthesia); lack of documentation can result in downcoding to 23650, reducing payment by approximately $150-200
Bill anesthesia services separately using appropriate codes (01630-01634) - these are not bundled with surgical code when provided by separate anesthesia practitioner
Impact: Captures additional revenue for facility or anesthesia group; failure to bill separately loses $200-400 in anesthesia reimbursement
Verify global period (10 days for this code) and do not separately bill E/M services during this window unless modifier 24 or 57 criteria are met
Impact: Prevents bundling denials and potential fraud flags; improper E/M billing can trigger recoupment of $100-200 per visit
When performed bilaterally (rare but possible), append modifier 50 and verify payer-specific bilateral payment policies
Impact: Medicare typically pays 150% for bilateral procedures ($615.72 total versus $410.48 unilateral)
For ASC settings, confirm LCD/NCD coverage for shoulder manipulation procedures and verify the code is on the ASC approved list
Ensures payment eligibility; performing non-covered procedures in ASC can result in complete denial of $410.48 professional fee plus facility costs

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Frequently asked questions

What is the difference between CPT 23655 and 23650?

CPT 23650 is closed treatment of shoulder dislocation with manipulation but without anesthesia, while 23655 specifically requires manipulation under anesthesia (general anesthesia or conscious sedation). The key differentiator is the administration of anesthesia to facilitate the reduction, which justifies the higher complexity and reimbursement of 23655.

How much does Medicare pay for CPT 23655 in 2025?

Medicare pays $410.48 for CPT 23655 in 2025 based on the national average for both facility and non-facility settings. This rate is calculated using 12.69 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary based on geographic locality adjustments.

Can I bill an E/M visit on the same day as CPT 23655?

Yes, but only with modifier 57 appended to the E/M code if the decision for surgery was made during that encounter. The E/M service must be significant and separately identifiable from the routine pre-procedure assessment. Documentation must clearly demonstrate the distinct evaluation that led to the surgical decision.

What modifiers are required when billing CPT 23655?

Laterality modifiers LT (left) or RT (right) are mandatory for CPT 23655. Additional modifiers may be needed based on circumstances: modifier 50 for bilateral procedures, modifier 54 for surgical care only, modifier 78 for related return to OR, or modifier 59 for distinct procedural services when billed with potentially bundled codes.

Is anesthesia separately billable with CPT 23655?

Yes, when provided by a separate qualified anesthesia practitioner, anesthesia services (CPT 01630-01634) are separately billable and not bundled with 23655. The surgeon bills 23655 for the manipulation procedure, while the anesthesiologist or CRNA bills appropriate anesthesia codes with time units.

What is the global period for CPT 23655?

CPT 23655 has a 10-day global period. This means routine postoperative care for 10 days following the procedure is included in the surgical fee and cannot be separately billed. Any E/M services during this period require modifier 24 and must be unrelated to the shoulder manipulation.

What documentation is needed to support medical necessity for CPT 23655?

Documentation must include confirmation of shoulder dislocation via imaging, physical exam findings, evidence of failed awake reduction attempts or clinical reasons why awake manipulation was contraindicated (severe muscle spasm, patient factors, complex dislocation), details of anesthesia type administered, manipulation technique used, and post-reduction confirmation of successful joint reduction with neurovascular assessment.