Summary & Overview
CPT 23625: Closed Treatment of Greater Humeral Tuberosity Fracture
CPT code 23625 represents the closed treatment of a greater humeral tuberosity fracture, a non‑open manipulation procedure used to realign the fractured tuberosity of the humerus. This code is relevant nationally for orthopedic, emergency, and ambulatory surgical providers because it captures a common fracture management approach that affects procedural coding, billing workflows, and payer coverage determinations across care settings. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain: a concise clinical context for when CPT code 23625 applies; the typical sites of service where the procedure is performed; and an overview of what to expect in payer coverage and billing practice (benchmarks and policy implications are summarized where available). The publication also outlines common modifiers and related coding considerations when present in payer policies. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 23625 describes a closed treatment of greater humeral tuberosity fracture. The procedure involves manipulation or adjustment of the fractured bone without open surgical exposure, aiming to restore alignment and promote healing.
Service Type: Fracture treatment / orthopedic closed manipulation
Typical Site of Service: Hospital outpatient department, ambulatory surgery center, or emergency department
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 67-year-old right-hand-dominant woman presents to the emergency department after a ground-level fall onto her outstretched left arm. She reports immediate shoulder pain and limited active range of motion. Plain radiographs of the left shoulder demonstrate a displaced greater tuberosity fracture of the humerus without glenohumeral dislocation. Orthopedics evaluates her in the ED and determines that a closed reduction with manipulation under conscious sedation is appropriate to restore tuberosity alignment and reduce impingement risk. The procedure includes pre-procedure consent, conscious sedation (monitored anesthesia care), fluoroscopic guidance for manipulation, post-reduction radiographs, and application of a sling with outpatient orthopedic follow-up in 1 week.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Physician as Primary Surgeon | Use when the reporting surgeon is the primary clinician performing the procedure. |
22 | Increased Procedural Services | Use when work required to perform the closed manipulation is substantially greater than typical (document intensification). |