CPT 23670Surgery

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CPT code 23670 covers open surgical repair of a shoulder dislocation combined with a fracture of the greater tuberosity of the humerus. This procedure realigns the shoulder joint and fixes the broken bone fragment using internal fixation devices.

Showing rates for

National Average

Base Medicare rate

$864.30

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

12.28

PE RVU (NF)

MP RVU

2.44

Total RVU

26.72

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

NCCI bundling edits

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Billing tips

Document both the dislocation reduction AND fracture fixation components separately in operative note with distinct descriptions of each element
Impact: Prevents downcoding to 23665 (closed treatment) which pays $279 less, protecting $864.30 reimbursement
Verify place of service coding matches actual location (POS 22 for outpatient hospital vs POS 24 for ASC) as facility/non-facility rates are identical at $864.30
Impact: Incorrect POS causes claim denials requiring resubmission and 15-30 day payment delays
For complex cases with extensive comminution or revision scenarios, use modifier 22 with documentation showing 25%+ additional time and effort compared to typical case
Impact: Can increase reimbursement by $172-259 (20-30% increase) when properly documented with comparison to standard procedure
Bill for imaging guidance separately (CPT 77002 for fluoroscopy) if used intraoperatively for fracture reduction verification, as this is not bundled
Impact: Additional $50-75 reimbursement for fluoroscopic guidance when documented as separate service
Ensure authorization obtained for both the surgical facility and surgeon services separately, as some payers require dual authorization for procedures over $800
Impact: Prevents denials for lack of authorization which can result in complete payment denial of $864.30
Code any documented nerve exploration or decompression separately with 64718 (ulnar/median) or 64719 (radial) if performed due to traction injury from dislocation
Impact: Additional $300-400 reimbursement when nerve procedure documented as distinct from primary shoulder surgery

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23670 in 2025?

The 2025 Medicare national average reimbursement for CPT 23670 is $864.30 for both facility and non-facility settings. This rate is based on 26.72 total RVUs multiplied by the 2025 conversion factor of $32.3465. Actual payment may vary by geographic locality based on GPCI adjustments.

What is the difference between CPT 23670 and 23665 for shoulder dislocation?

CPT 23670 is for open surgical treatment with internal fixation of the greater tuberosity fracture, while 23665 covers closed treatment requiring anesthesia without fixation. Code 23670 requires surgical incision, fracture fixation with hardware, and pays $864.30 compared to significantly less for closed treatment. The key documentation distinction is the use of internal fixation devices.

Can CPT 23670 be billed with rotator cuff repair codes?

Yes, rotator cuff repair (29827 or 23410-23412) can be billed separately with CPT 23670 if the rotator cuff tear is distinctly documented as separate from the fracture fixation site and requires independent repair. Use modifier 59 or XS to indicate distinct procedural service. However, simple rotator cuff reattachment to the fixed greater tuberosity is considered inclusive.

What diagnosis codes support medical necessity for CPT 23670?

Primary ICD-10 codes include S42.271A-S42.272A (displaced greater tuberosity fracture, initial encounter) combined with S43.004A-S43.006A (shoulder dislocation). The diagnosis must reflect both the fracture and dislocation components. Undisplaced fractures or isolated dislocations without fracture may not support medical necessity for open treatment.

How many work RVUs is CPT 23670 worth in 2025?

CPT 23670 has 12.28 work RVUs in 2025, reflecting the significant physician effort for this complex procedure. The total RVU value is 26.72, which includes 12.00 practice expense RVUs and 2.44 malpractice RVUs. This places it in the moderate-to-high complexity range for orthopedic shoulder procedures.

Does CPT 23670 have a 90-day global period?

Yes, CPT 23670 carries a 90-day global surgical package. This includes pre-operative evaluation on the day before or day of surgery, the surgical procedure itself, and all routine postoperative care for 90 days. Any complications requiring return to OR during this period require modifier 78, while unrelated procedures need modifier 79.

What modifiers are required when billing CPT 23670?

Laterality modifiers LT (left) or RT (right) are mandatory for CPT 23670 and claims will deny without them. Additional modifiers may include 22 (increased complexity), 62 (co-surgeons), 54 (surgical care only), or 80 (assistant surgeon) depending on the specific circumstances. Modifier 25 may be needed if a separate E/M service is documented on the same date.