CPT code 23620: Greater humeral tuberosity fracture billing guide

Key takeaways

CPT code 23620 covers closed treatment of a greater humeral tuberosity fracture without manipulation.

The code carries 2.49 work RVUs in 2026, which works out to roughly $271 in a facility and $310 in an office.

The 90-day global period bundles routine follow-up visits into the procedure payment. Bill separately only for unrelated services.

Laterality modifiers -LT and -RT are required on Medicare claims, and omitting them is a common denial trigger for shoulder fracture codes.

Practice management software like Pabau ties the clinical record to the procedure code at the point of care, so denials from thin documentation drop.

CPT code 23620 covers the closed treatment of a greater humeral tuberosity fracture, without manipulation. The American Medical Association (AMA) owns and maintains the CPT code set. It places 23620 in the Musculoskeletal System chapter, inside the shoulder fracture and dislocation range of 23500 to 23680.

“Closed treatment” means no surgical incision is made to reach the fracture site. “Without manipulation” means the fragments are not repositioned by hand. The treating clinician judges the alignment acceptable and manages the injury conservatively.

This code applies only when the clinical decision is conservative management. The table below summarizes the key code facts at a glance.

Clinical overview: Greater tuberosity fracture without manipulation

The greater tuberosity is the bony prominence on the lateral side of the proximal humerus. It anchors the supraspinatus, infraspinatus, and teres minor tendons of the rotator cuff. Fractures here usually follow a direct blow to the shoulder or a fall onto an outstretched hand. They also turn up alongside an anterior shoulder dislocation.

CPT 23620 applies when the treating physician finds the fragment minimally displaced and conservative management appropriate. Most clinical protocols put that threshold under 5 mm of displacement. Key clinical indications include:

• Greater tuberosity fracture with minimal or no displacement confirmed on imaging
• No significant rotator cuff dysfunction associated with the displacement
• Patient is a candidate for conservative management, meaning immobilization, physical therapy, and pain control
• No concurrent injuries requiring surgical intervention at the same operative session
• Imaging (X-ray, MRI, or CT) confirms fracture identity and displacement measurement

When displacement passes clinical thresholds or rotator cuff integrity is compromised, the physician may choose 23625 or an open reduction procedure instead. Coding accuracy rests on two entries in the record. Document the displacement measurement, and document the rationale for managing the injury conservatively.

CPT code 23620 modifiers

Modifiers explain the circumstances of a procedure, and they often decide whether a claim is paid at all. For CPT 23620, the following modifiers apply most often.

Medicare requires a laterality modifier, -LT or -RT, on every shoulder procedure code. Missing it is a preventable denial, and the remittance comes back with one of the standard denial codes. Front-end scrubbing catches it, which is the difference between a clean claim and a rework queue.

Confirm your payer’s modifier policy before you submit. Requirements vary between commercial plans and Medicare Advantage products, and a policy that held last year may not hold now.

CPT 23620 RVU values

Relative Value Units (RVUs) are the foundation of Medicare physician payment under the Resource-Based Relative Value Scale (RBRVS). The Centers for Medicare and Medicaid Services (CMS) republishes them every year through the CMS fee schedule lookup. The figures below come from the 2026 physician fee schedule.

The malpractice RVU is a single value of 0.50 and does not shift with the setting. Practice expense RVUs do shift, because CMS accounts for overhead differently in each place of service.

In a hospital or ambulatory surgical center, the facility absorbs the overhead and bills for it separately. In a physician office the practice carries those costs itself, so the non-facility figure is higher. Use the FastRVU lookup tool to pull location-adjusted figures for your own setting.

Medicare reimbursement for CPT code 23620

Medicare pays for 23620 by multiplying total RVUs by the annual conversion factor, then adjusting for geographic practice cost indices (GPCIs). The 2026 conversion factor is $33.4009. Because GPCIs vary by payment locality, two practices billing the same procedure on the same day can be paid different amounts.

The national averages below apply the 2026 conversion factor to the total RVUs above, with no locality adjustment.

Treat those two figures as benchmarks, not quotes. Run your own payment locality through the CMS fee schedule search for the rate you will actually be paid. Commercial rates for 23620 usually sit above Medicare and depend on each payer contract.

ICD-10 codes commonly paired with CPT code 23620

Every CPT claim needs a supporting ICD-10-CM diagnosis code to establish medical necessity. For 23620, the diagnosis has to match the fracture site, the laterality, and the encounter type. The S42 category covers fractures of the shoulder and upper arm.

The 7th character matters as much as the base code. Use “A” for the initial encounter while the patient is under active treatment. Use “D” for subsequent encounters during healing, and “S” for sequela. A code such as S49.109P marks a much later encounter, where the fracture has healed in malunion.

Plenty of shoulder fracture claims are denied because the 7th character does not match the visit context. Verify every pairing against the current tabular list in the CDC ICD-10-CM tool.

Documentation requirements for CPT 23620

Claims for CPT code 23620 need documentation that supports both the diagnosis and the treatment approach chosen. Thin records are the leading reason orthopedic claims are denied or downgraded on audit. Practice management software like Pabau captures clinical documentation at the point of care, so the note and the claim come from the same encounter.

A complete medical record for 23620 should include:

• Imaging report: X-ray or advanced imaging confirming a greater tuberosity fracture, with the displacement measurement written down
• Clinical examination findings: Shoulder range of motion, impingement testing such as the Neer’s test, neurovascular status, and pain assessment
• Fracture characterization: An explicit note that the fracture is closed, that manipulation was not performed, and why
• Treatment plan: The conservative management plan, including immobilization type, duration, and follow-up schedule
• Physician attestation: A signed and dated note from the treating physician recording the clinical decision
• Procedure note: Even for non-surgical fracture management, a note covering the encounter, assessment, and plan is required

Payers running post-payment audits will ask for all of it. Structured records linked to the submitted code are what keep an audit short, which is the practical side of billing compliance. Software that connects the clinical note to the billing workflow does that linking for you.

Global period and post-operative considerations for CPT code 23620

CPT code 23620 carries a 90-day global period under Medicare’s global surgical package. Verify the current global period indicator in the CMS fee schedule for the active year. Inside that window, routine follow-up services are bundled into the procedure payment and cannot be billed separately to Medicare.

Knowing what is bundled protects you from underpayment and from compliance risk at the same time. Watch the filing clock too, because a late claim is denied on the timely filing limit no matter how clean the coding is.

Rehab that you refer out is billed by the treating provider, not by you. Practices that run rehab in house bill it under their own codes, usually from a physical therapy EMR rather than the surgical record.

Related CPT codes in the shoulder fracture family

Codes 23600 through 23630 cover closed and open treatment of proximal humerus fractures at different levels of intervention. Choosing between them means separating manipulation from open reduction, and the broad anatomical site from the specific one.

The most common selection error is billing 23600 instead of 23620. Code 23600 covers the proximal humerus broadly, while 23620 is specific to the greater tuberosity. When imaging and the clinical note both place the fracture at the greater tuberosity, 23620 is the precise choice. Auditors can flag 23600 as under-coded against that record.

Injuries further down the humerus leave this range altogether. Percutaneous fixation of a humeral condylar fracture belongs to 24582 in the elbow subheading.

How Pabau simplifies billing for CPT code 23620

Greater tuberosity fracture claims are denied more often for documentation reasons than for coding errors. The physician writes the encounter in one system, the imaging report sits in another, and the billing team rebuilds the medical necessity case from fragments. Pabau’s claims management software holds those pieces in one workflow.

Claims leave Pabau through our Claim.MD integration, the clearinghouse that submits them electronically to payers. Remittances and rejections land back in the same screen. A missing -LT modifier gets fixed against the record it came from, rather than in a spreadsheet nobody owns.

For orthopedic teams and sports medicine software users, Pabau handles three billing challenges that codes like 23620 create:

• Documentation at the point of care: Pabau’s digital intake forms capture the fracture presentation and imaging findings before the patient leaves. They also record the rationale for conservative management, so billers code from a complete record.
• Code-to-note linkage: When a clinician selects CPT 23620, the system points to the clinical record behind it. That cuts the back-and-forth between billing and clinical teams while a claim is being prepared.
• Claim status tracking: Billers follow submissions, spot denials, and manage resubmissions in the same platform they use for scheduling and records. That turns denial management into a daily habit instead of a quarterly cleanup.

For practices running a high volume of musculoskeletal codes, keeping practice management workflows in one place cuts admin overhead. Less overhead means less claim lag and fewer denials.

Streamline orthopedic billing from note to claim

Pabau connects clinical notes, imaging references, and CPT codes in one workflow. Billers spend less time chasing records, so orthopedic practices submit cleaner claims the first time.

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Conclusion

Precision is what 23620 pays for. The code is narrow by design. The practices that get paid for it are the ones whose records show why conservative management was the right call.

Most denials on this code trace back to something the clinician knew at the visit and nobody wrote down. That is a workflow problem before it is a coding problem, which is good news, because a workflow is something you can change this month.

Fix the record and the claim follows. Pabau’s claims management and digital forms capture that evidence while the patient is still in the room. Book a demo to see how Pabau keeps orthopedic documentation and claims in step.

Continue your research

Coding a shoulder dislocation instead? CPT code 23462 walks through the open treatment pathway, its RVU values, and the modifiers that keep the claim paid.

Excising a mass around the shoulder? CPT code 23073 covers soft tissue tumor removal in the shoulder and the documentation that supports it.

Billing a biceps repair at the elbow? CPT code 24340 explains what the operative note has to show before the claim goes out.

Documenting a sequela rather than a new injury? ICD-10 code S43.312S shows how the 7th character changes the diagnosis you submit.

Need a functional baseline for recovery? functional status questionnaire gives you a reusable form for tracking progress after a fracture.

Frequently asked questions