CPT code 23670: Open treatment of shoulder dislocation with greater tuberosity fracture

Key takeaways

CPT code 23670 covers open treatment of a shoulder dislocation with a fracture of the greater humeral tuberosity.

Internal fixation placed in the same operative session is bundled into 23670 and cannot be billed separately.

The code carries a 90-day global period, so routine follow-up inside that window is not separately payable.

Fracture site decides the code. 23670 and 23665 cover the greater tuberosity, while 23675 and 23680 cover the humeral neck.

Practice management software like Pabau ties the operative note to the claim, so modifiers and ICD-10 pairings are not lost in between.

CPT code 23670 covers open treatment of a shoulder dislocation with a fracture of the greater humeral tuberosity. Internal fixation is included when the surgeon performs it. That is the official descriptor maintained by the American Medical Association (AMA).

The code sits in the Musculoskeletal System section of the CPT codebook, under Shoulder, in the 23000-23929 range. You report it when a glenohumeral dislocation comes with a greater tuberosity fracture and the surgeon opens the joint to treat it.

The phrase “includes internal fixation, when performed” does the billing work here. Hardware placed during the same session is part of 23670, not a second line on the claim.

CPT 23670 fee schedule and Medicare reimbursement

Medicare payment for CPT 23670 varies by locality, place of service, and the Medicare Administrative Contractor (MAC) that processes the claim. The CMS Physician Fee Schedule (MPFS) lookup tool is the authoritative source for current rates.

The figures below are 2026 national average estimates. Check your own locality in the MPFS before you use any of them in a revenue forecast.

Geographic Practice Cost Index (GPCI) factors move these national averages up or down by locality. A practice in an expensive metro area is paid more than a rural provider billing the same code. Private payer rates are negotiated separately and usually sit above Medicare, though they vary by contract.

RVU breakdown for CPT 23670

Relative Value Units (RVUs) decide what Medicare pays for CPT 23670. Three components make up the total. Work RVUs cover physician effort, practice expense RVUs cover overhead, and malpractice RVUs cover liability cost.

Multiply the total RVU by the annual conversion factor to get the base payment before geographic adjustment. CMS publishes that conversion factor each year in the fee schedule final rule.

These values are rounded from published CMS figures, so confirm them in the MPFS lookup or the AMA’s CPT coding resources before modeling revenue. Practice expense runs higher outside a facility, because the practice then absorbs overhead the hospital would otherwise carry.

Payment rarely matches the arithmetic exactly. Practices using revenue reporting can compare what a payer actually paid against the RVU-based amount they expected, code by code.

Modifiers for CPT code 23670

Modifier choice on CPT 23670 depends on the clinical scenario, the payer, and the MAC’s Local Coverage Determinations (LCDs). No modifier is accepted universally, so confirm the requirement before you submit. The ones below come up most often.

Payer rules differ on laterality. Some MACs want -LT or -RT on every unilateral procedure, while others ask for it only on bilateral claims. Teams billing several shoulder procedures in one session should also check the National Correct Coding Initiative (NCCI) bundling edits.

Modifier -22 is the one that gets tested. Accurate digital documentation at the point of care is what keeps that claim defensible. A reviewer may ask months later why the case was harder than usual.

ICD-10 codes commonly billed with CPT 23670

CPT 23670 needs a supporting ICD-10-CM diagnosis that shows a shoulder dislocation with a fracture of the greater tuberosity. Codes in the S43.0 and S42.2 ranges carry most of these claims.

A 7th character is mandatory. Use A for the initial encounter, D for a subsequent encounter, and S for sequela. Make sure the encounter type matches the date of service on the claim.

Use the most specific code the documentation supports. When the operative note names the greater tuberosity and confirms displacement, S42.251A or S42.252A beats an unspecified fracture code.

The subluxation codes are the common mispick. S43.001A and S43.002A describe subluxation of the shoulder joint rather than dislocation, so they do not support an open dislocation repair. A crosswalk reference such as the AAPC CPT-to-ICD-10 crosswalk confirms a valid pairing before submission.

Shoulder injuries often arrive through a rehabilitation or athletic route rather than an emergency room. Practices running sports medicine software see the same codes across assessment, surgery, and return-to-play follow-up.

Billing guidelines and documentation requirements for CPT 23670

A clean 23670 claim rests on an operative note that justifies an open approach. Closed reduction is the default treatment for this injury, so payers look for the reason the surgeon opened the joint instead.

Key documentation elements required in the operative note:

• Confirmation that closed reduction was attempted or contraindicated, with the rationale for open treatment
• Intraoperative identification and description of the greater tuberosity fracture fragment
• The dislocation type, whether anterior, posterior, or inferior
• If internal fixation was applied, the hardware type, size, and method, such as cannulated screws or suture anchors
• If fixation was not applied, an explicit note saying so, which supports the code’s “when performed” language
• Laterality, stated as right or left shoulder
• Pre- and post-operative neurovascular status of the extremity

Bundled fixation is a pattern across the fracture codes, not a quirk of 23670. CPT 21365 rolls internal fixation into a facial fracture repair in much the same way, and it carries the same duty to describe the hardware.

The 90-day global period means routine follow-up care in the 90 days after surgery is bundled into 23670. An unrelated evaluation and management visit inside that window needs modifier -24. Hardware removal on a later date is billed with CPT 20680.

Practices that also deliver physical therapy and rehabilitation need that global period boundary visible in the record. Otherwise a therapy visit gets billed as postoperative follow-up, or the reverse.

Related CPT codes: 23650, 23655, 23665, 23675, and 23680

Two variables separate this family of codes. The first is the approach, closed or open. The second is where the humerus fractured, if it fractured at all. Reading the group that way turns the most common orthopedic billing error into a two-question check.

How to choose between 23670, 23665, and 23675

Start with the approach. CPT 23670 applies only when the surgeon makes an incision to reach and reduce the fracture-dislocation. If the same injury is reduced without an incision, 23665 is the code.

Then read the fracture site. CPT 23675 is not the anesthesia version of 23665, which is where coders slip. It covers closed treatment when the fracture sits at the surgical or anatomical neck of the humerus instead of the greater tuberosity.

The same site logic separates 23670 from 23680. Use 23680 when the note places the fracture at the surgical or anatomical neck and the surgeon treated it open. Both codes include internal fixation when performed, so hardware never distinguishes them. Fracture site does.

Descriptors change with each annual CPT release. Verify the wording in the codebook or through the AAPC CPT code lookup when a claim is borderline.

Coders working the wider shoulder range meet the same open-versus-closed question elsewhere in the 23000 series. CPT 23472 covers total shoulder arthroplasty, and CPT 23146 covers excision of a bone cyst in the proximal humerus.

How practice management software supports CPT 23670 billing

Most orthopedic billing teams work across two screens. A code reference sits in one window and the billing system in the other. The coder reads the operative note, picks 23670, then retypes it. That hand-off is where a laterality modifier gets dropped or an ICD-10 pairing goes unchecked.

Practice management software like Pabau keeps the documentation and the claim in one record. Code capture happens inside the encounter, so the code is attached to the note the surgeon actually wrote. Pabau’s claims management software then carries that detail through to submission.

Denials come back sorted by code rather than as one monthly figure. A billing team can see that 23670 rejections cluster around a missing modifier, fix the template, and stop the pattern. On a code paying several hundred dollars a claim, catching that in week two protects meaningful revenue.

Reduce CPT 23670 claim denials with connected billing

Pabau links clinical documentation to claim submission. Orthopedic practices apply the right modifiers, validate ICD-10 pairings, and watch reimbursement on codes like CPT 23670.

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Conclusion

Every 23670 claim comes down to two facts in the operative note. The surgeon opened the joint, and the fracture sat at the greater tuberosity. Read those two first, and the modifier, the diagnosis pairing, and the global period all fall into place behind them.

The trade-off worth remembering is documentation effort. This code pays well and carries a 90-day global period, so payers read the note closely. A note that states the approach, the fracture site, the laterality, and the fixation method answers the reviewer before they ask.

Keeping that note and the claim in one system is what stops the detail leaking on the way to the payer. Book a demo to see how Pabau supports orthopedic billing from operative note through to remittance.

Continue your research

Coding other shoulder procedures? CPT 23472 covers total shoulder arthroplasty billing, from the descriptor through to reimbursement.

Taking the hardware out later? CPT 20680 is the deep implant removal code you bill once fixation from a 23670 repair comes out.

Working further down the humerus? CPT 23146 covers excision of a bone cyst in the proximal humerus with autograft.

Need a diagnosis code for a bruised upper arm? ICD-10 S40.022A shows how laterality and encounter characters work on a soft tissue injury.

Billing an open fracture elsewhere? ICD-10 S72.041B shows how the 7th character changes once a fracture is classified as open.

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