Summary & Overview
CPT 23620: Closed Treatment of Greater Humeral Tuberosity Fracture
CPT code 23620 denotes the closed treatment of a greater humeral tuberosity fracture without manipulation or adjustment of the fractured bone. This code captures a nonoperative clinical pathway for proximal humerus fractures that commonly present in emergency, outpatient, and ambulatory surgery settings. Nationally, accurate coding of such procedures affects clinical documentation, utilization tracking, and payment for fracture care across public and commercial payers.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of typical clinical scenarios for code use, payment and utilization benchmarks where available, and guidance on documentation elements required to support the code’s assignment. The publication summarizes common modifiers and related administrative considerations, highlights the typical sites of service for billing, and situates CPT code 23620 within the broader care pathway for proximal humerus fractures.
This summary is intended for providers, coding professionals, and policy analysts seeking a concise reference on the code’s clinical meaning, operational context, and implications for billing and reimbursement nationally.
Billing Code Overview
CPT code 23620 describes a closed treatment of greater humeral tuberosity fracture in which the provider performs nonoperative management without manipulation or adjustment of the fractured bone. The procedure involves care directed at a fracture of the greater tuberosity of the humerus where the fracture is managed closed, typically through immobilization, splinting, or other noninvasive measures rather than open reduction or internal fixation.
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Service type: Closed fracture treatment (nonoperative fracture management)
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Typical site of service: Ambulatory surgical center, hospital outpatient department, emergency department, or physician office depending on clinical presentation and available resources.
Clinical & Coding Specifications
Clinical Context
A 58-year-old female presents to the emergency department after a ground-level fall onto her outstretched right arm. She reports acute shoulder pain, limited range of motion, and swelling over the lateral shoulder. Radiographs demonstrate an isolated greater tuberosity fracture of the proximal humerus without significant displacement. The orthopedic provider documents decision for nonoperative closed management with sling immobilization and analgesia during the ED visit and instructs early outpatient orthopedic follow-up within 7–10 days. The clinical workflow includes ED evaluation, plain radiographs, closed treatment application (sling or immobilizer) performed by the treating clinician without manipulation of the fracture fragments, documentation of fracture type and stability, and scheduling for orthopedic clinic follow-up and repeat imaging.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier | Used when no other modifier applies. |
11 | Normal billing/standard service | When the service is provided under usual circumstances without unusual effort. |