CPT 23665Surgery

Cltx sho dslc fx gr hmrl tbr

CPT 23665 covers the closed treatment (without surgery) of a dislocated shoulder that also involves a fracture of the greater tuberosity, which is a bony bump on the upper arm bone where rotator cuff muscles attach.

Showing rates for

National Average

Base Medicare rate

$442.82

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

4.66

PE RVU (NF)

8.08

MP RVU

0.95

Total RVU

13.69

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

NCCI bundling edits

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Billing tips

Ensure documentation clearly describes BOTH the shoulder dislocation AND the greater tuberosity fracture with specific mention of closed reduction of each component
Impact: Missing fracture documentation may result in downcoding to 23650 (simple dislocation), losing $122+ in reimbursement
Bill in the non-facility setting when performed in the emergency department or clinic with your own equipment and staff to capture the higher rate
Impact: Non-facility payment is $442.82 vs $406.27 facility rate - a difference of $36.55 per procedure
Document the type and level of anesthesia/sedation separately; conscious sedation (99151-99153) may be billable in addition when performed by the operating physician with a qualified observer
Impact: Adds $75-150 in additional reimbursement when appropriately documented and billed
Capture pre- and post-reduction imaging interpretation separately if you provide the professional component; use 73030-26 for shoulder X-ray interpretation
Impact: Professional component adds approximately $15-25 per X-ray series (typically 2 series: pre and post reduction)
For Medicare patients, verify the procedure meets medical necessity criteria and document failed attempts at less complex reduction before proceeding
Impact: Prevents denials and audit flags; LCD violations can result in 100% payment denial ($442.82 loss)
Do not bill separately for manipulation or casting/splinting as these are included in the global procedure; immobilization is bundled
Impact: Unbundling attempts trigger audits and may result in recoupment plus penalties (potential $500+ in compliance costs)

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Frequently asked questions

What is the difference between CPT 23665 and 23650 for shoulder dislocation billing?

CPT 23665 includes treatment of a shoulder dislocation WITH a fracture of the greater tuberosity requiring reduction of both components, while 23650 covers simple shoulder dislocation without fracture. The 2025 Medicare payment difference is approximately $122 ($442.82 for 23665 vs $320 range for 23650), reflecting the increased complexity of managing the fracture component.

Can I bill an E/M code with CPT 23665 on the same day?

Generally no, unless the E/M service is separately identifiable and documented with modifier 25. The evaluation leading to the decision for reduction is bundled into 23665. You may bill a separate E/M only if significant, separately identifiable evaluation was performed for unrelated conditions or if the initial evaluation occurred before the decision for the procedure was made.

How much does Medicare pay for CPT 23665 in 2025?

Medicare pays $442.82 for non-facility settings and $406.27 for facility settings under the 2025 national average rates. Actual payment may vary by geographic locality due to GPCI adjustments. The procedure has a total RVU of 13.69 (4.66 work RVU, 8.08 non-facility PE RVU, 0.95 MP RVU).

Is conscious sedation separately billable with CPT 23665?

Yes, moderate conscious sedation (99151-99153) may be billed separately when performed by the same physician doing the reduction, provided a separate qualified observer is present and all sedation documentation requirements are met. This can add $75-150 to total reimbursement depending on time and patient age.

What modifiers are required when billing CPT 23665?

Laterality modifiers LT (left) or RT (right) are mandatory for claim processing. Additional modifiers may include 54 (surgical care only), 55 (postoperative care only), 76 (repeat procedure by same physician), or 77 (repeat procedure by different physician) depending on the specific clinical circumstances and care arrangement.

Can CPT 23665 be billed for pediatric patients?

Yes, CPT 23665 can be billed for pediatric patients with appropriate shoulder anatomy (typically adolescents), though the injury pattern is less common in young children. Reimbursement rates are the same regardless of patient age. Documentation should reflect age-appropriate informed consent and assent procedures.

What documentation is needed to prevent downcoding of CPT 23665 to a simple dislocation code?

Documentation must explicitly describe both the shoulder dislocation AND the greater tuberosity fracture, include pre-reduction imaging confirming the fracture fragment, detail the closed reduction technique addressing both components, and provide post-reduction imaging showing adequate reduction of the fracture. Radiologist interpretation reports should specifically mention the tuberosity fracture.