Summary & Overview
CPT 23630: Open Fixation of Greater Humeral Tuberosity Fracture
CPT code 23630 denotes open surgical fixation of a greater humeral tuberosity fracture using internal fixation devices such as pins or screws. Nationally, this procedure is relevant to orthopedic trauma pathways and surgical services for proximal humerus fractures, with implications for operating-room resource use, implant costs, and post-operative rehabilitation.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and payer coverage scope. The publication provides benchmarks and payment context where available, summarizes common billing and coding considerations tied to fixation procedures, and highlights policy and reimbursement updates that affect hospital and ambulatory surgery settings.
This overview is intended for clinicians, billing professionals, and policy analysts seeking a national perspective on coding and payer coverage for surgical fixation of greater humeral tuberosity fractures. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 23630 describes an open treatment of a greater humeral tuberosity fracture. The procedure involves surgical exposure of the fracture site on the proximal humerus and internal fixation using implants such as pins or screws to reduce and stabilize the greater tuberosity fragment.
Service type: Open orthopedic fracture fixation
Typical site of service: Hospital operating room or outpatient ambulatory surgery center
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old right-hand–dominant male presents after a fall onto his outstretched hand with acute left shoulder pain, swelling, and limited active range of motion. Radiographs and CT confirm a displaced greater tuberosity fracture of the proximal humerus with cortical step-off and rotational displacement. The patient has intact distal neurovascular status and medical clearance for surgery. The orthopedic surgeon schedules an open reduction and internal fixation procedure to anatomically reduce the greater tuberosity fragment and secure fixation using screws and/or small plates.
Preoperative workflow includes history and physical, informed consent, anesthesia evaluation (usually general or regional block), and perioperative antibiotics. Intraoperative steps include beach-chair positioning, deltoid-splitting or deltopectoral approach, direct visualization of the tuberosity fragment, debridement of fracture surfaces, provisional fixation with K-wires or clamps, definitive fixation with screws (cannulated or solid) ± suture anchors, intraoperative fluoroscopy to confirm reduction, and wound closure. Postoperative care includes immobilization in a sling, pain management, early passive range-of-motion per surgeon protocol, and radiographic follow-up to assess healing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the surgeon's professional component is billed separately from the facility (rare for OR procedures billed by facility). |