Summary & Overview
CPT 23615: Open Treatment of Proximal Humerus Neck Fracture
CPT code 23615 covers the open surgical treatment of fractures to the surgical or anatomical neck of the proximal humerus, with optional repair of the tuberosities and possible use of internal fixation. This code is routinely used in orthopedic trauma care for displaced proximal humerus fractures that require operative management. Nationally, use of this code reflects patterns of surgical management for shoulder fractures among adult patients and factors such as fracture complexity, available surgical resources, and local practice norms.
Key payers considered in related analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, common billing and coding considerations, payer coverage patterns, and typical sites of service. The content summarizes where the code is applied clinically, common procedural variants (repair of tuberosities and optional fixation), and operational contexts for hospitals and ambulatory surgery centers.
This publication is intended to orient clinicians, billing professionals, and policy analysts to the primary clinical meaning of CPT code 23615, the payers commonly involved in coverage, and the types of benchmarks and policy items usually relevant to this service. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 23615 describes the open treatment of a surgical or anatomical neck fracture of the proximal humerus. The procedure may include repair of the greater and/or lesser tuberosities and may involve the use of internal fixation devices such as pins or screws when required.
-
Service type: Open surgical fracture treatment (orthopedic trauma surgery)
-
Typical site of service: Hospital operating room or ambulatory surgery center for operative management of proximal humerus fractures
Clinical & Coding Specifications
Clinical Context
A 68-year-old right-hand dominant female presents after a ground-level fall onto her left shoulder with severe pain, swelling, and limited range of motion. Imaging (AP and trans-scapular Y radiographs and CT when indicated) demonstrates a displaced surgical neck fracture of the proximal humerus with possible tuberosity involvement. After closed reduction attempts and orthopaedic evaluation, the decision is made for open treatment of the surgical neck fracture with possible internal fixation (pins, screws, or plate) and repair of greater tuberosity fragments as needed.
The clinical workflow includes preoperative evaluation (history, focused shoulder exam, neurovascular assessment, and imaging), pre-op medical clearance, informed consent documenting open reduction and internal fixation intent, intraoperative open reduction with fixation and tuberosity repair as needed, immediate postoperative neurovascular check, pain control and immobilization (sling), and early outpatient follow-up with radiographs and physical therapy as clinically indicated. Typical perioperative documentation includes procedure note describing exposure, fracture reduction method, implants used (or statement if none used), tuberosity repair, estimated blood loss, and any intraoperative complications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typical (e.g., complex reduction, prolonged dissection). |