CPT 23675Surgery

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CPT code 23675 covers the closed treatment (manipulation without surgery) of a shoulder dislocation that also involves a fracture of the greater tuberosity of the humerus, requiring manipulation under anesthesia or sedation.

Showing rates for

National Average

Base Medicare rate

$557.98

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

6.27

PE RVU (NF)

9.73

MP RVU

1.25

Total RVU

17.25

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

NCCI bundling edits

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Billing tips

Verify and document whether procedural sedation was provided and bill separately with appropriate codes (99151-99153 or 99155-99157) when performed by the operating physician
Impact: Additional $75-150 revenue per case when moderate sedation is documented and billed appropriately
Always append laterality modifier (LT or RT) on first submission to avoid automatic denial and resubmission delays
Impact: Prevents 15-30 day payment delays and reduces administrative rework costs of $25-40 per rebilled claim
Bill in facility setting (ASC or hospital outpatient) when possible as the reduced physician payment ($503.96) is offset by facility fees paid separately, improving total reimbursement
Impact: Total reimbursement (physician + facility) typically $2,500-4,000 vs. $557.98 in office setting
Document pre- and post-reduction neurovascular examinations thoroughly, including specific nerve testing (axillary, radial, median, ulnar) and pulse checks to support medical necessity and reduce liability
Impact: Reduces denial rate by approximately 12% and provides essential medicolegal protection in the event of complications
Obtain and document interpretation of post-reduction radiographs showing adequate reduction and fracture position to satisfy payer requirements for procedure completion
Impact: Prevents denial for incomplete procedure documentation, protecting full $557.98 reimbursement
When performed in emergency department, coordinate with facility to ensure professional component is billed separately from facility fee to avoid bundling issues
Ensures full professional fee collection; bundling errors can result in 100% payment loss ($557.98)

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 23675 in 2025?

The 2025 Medicare national average reimbursement for CPT 23675 is $557.98 in non-facility settings and $503.96 in facility settings. These rates are based on total RVUs of 17.25 (6.27 work RVU, 9.73 non-facility PE RVU, 1.25 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 23675 and 23650?

CPT 23675 is for closed treatment of shoulder dislocation WITH greater tuberosity fracture requiring manipulation, while CPT 23650 is for shoulder dislocation WITHOUT fracture requiring manipulation. The presence of a greater tuberosity fracture that requires manipulative treatment is the key differentiator, and 23675 has higher RVUs (17.25 vs 13.03) reflecting the additional complexity.

Can I bill CPT 23675 with an E/M code on the same day?

Yes, you can bill an E/M code with CPT 23675 on the same day if the E/M represents a separately identifiable service (such as the initial evaluation and decision for treatment) by appending modifier 25 to the E/M code. Documentation must clearly demonstrate the E/M service was distinct from the pre-procedure assessment inherent in the procedure code.

Is moderate sedation included in CPT 23675 or billed separately?

Moderate sedation is NOT bundled into CPT 23675 and may be billed separately using codes 99151-99153 (when performed by the same physician) or 99155-99157 (when performed by a different physician). Document sedation start/stop times, medications administered, and monitoring performed to support separate billing.

What documentation is required to justify CPT 23675 over simpler dislocation codes?

You must document pre-reduction imaging showing both glenohumeral dislocation AND greater tuberosity fracture, describe the manipulation technique used to reduce both components, document use of sedation or anesthesia, and include post-reduction imaging confirming adequate reduction. The operative note must specify that the fracture required manipulative treatment, not just the dislocation alone.

How many RVUs is CPT code 23675 worth in 2025?

CPT 23675 has a total of 17.25 RVUs in 2025, consisting of 6.27 work RVUs, 9.73 non-facility practice expense RVUs (8.06 facility PE RVUs), and 1.25 malpractice RVUs. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

What modifier is required when billing CPT 23675?

Laterality modifiers LT (left) or RT (right) are required for CPT 23675 to indicate which shoulder was treated. Missing laterality modifiers will result in automatic claim denial by most payers. Other modifiers like 54, 55, 62, or 76 may be appropriate in specific circumstances involving shared care or repeat procedures.