CPT 23680 Reimbursement & Benchmarks | OpenPayer

Summary & Overview

CPT 23680: Open Treatment of Shoulder Dislocation with/without Humerus Neck Repair

CPT code 23680 captures an open surgical procedure to reduce a shoulder dislocation and, when present, to perform open repair of a surgical or anatomical neck fracture of the humerus, with or without internal fixation. This code is used for definitive operative management when closed reduction is inadequate or when concurrent fracture fixation is required. Nationally, accurate coding for this procedure matters for clinical documentation, appropriate payment, and tracking of surgical shoulder care trends.

Key payers relevant to national billing and coverage considerations include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical scope of the code, typical settings where the service is delivered, common modifier usage, and the types of analyses usually provided for procedure-level publications (benchmarks, utilization patterns, and policy implications). The summary clarifies what this CPT code represents, the typical clinical scenarios prompting its use, and what to expect in deeper sections: utilization benchmarks, payer coverage notes, and clinical context for operative management of dislocation with or without proximal humerus fracture. Data not available in the input will be noted explicitly in detailed sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 23680shoulder surgeryopen reductionproximal humerus fractureorthopedic surgeryoperative repairambulatory surgeryhospital OR

Billing Code Overview

CPT code 23680 describes an open surgical treatment of shoulder dislocation and may include an open repair of a surgical or anatomical neck fracture of the proximal humerus, performed with or without internal fixation (pins, screws, or similar implants). The procedure involves a surgical incision to access the shoulder joint, reduction (realignment) of the dislocation, and repair of associated fractures when present.

Service type: Surgical — Open shoulder procedure involving reduction and possible fracture fixation

Typical site of service: Hospital operating room or ambulatory surgical center

Clinical & Coding Specifications

Clinical Context

A 52-year-old male presents to the emergency department after a fall onto his outstretched right arm. He reports severe shoulder pain, visible deformity, and inability to move the arm. Initial evaluation with radiographs demonstrates an anterior shoulder dislocation with comminution involving the surgical neck of the proximal humerus. Closed reduction attempts in the ED are unsuccessful or not feasible due to an associated displaced surgical neck fracture. The orthopedic surgeon schedules an operative open treatment under general anesthesia.

Perioperative workflow: preoperative evaluation and informed consent in the ED or preop clinic; regional nerve block or general anesthesia; operative positioning and sterile preparation in the OR; a deltopectoral or anterolateral incision to expose the glenohumeral joint and proximal humerus; open reduction of the dislocation and reduction/repair of the surgical or anatomic neck fracture with or without internal fixation (plates, screws, pins) as indicated; intraoperative imaging to confirm alignment; wound closure and postoperative recovery. Postoperative care includes pain control, immobilization in a sling or shoulder immobilizer, physical therapy referral, and follow-up radiographs to monitor healing.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the procedure requires substantially greater work than typical (extensive dissection, prolonged OR time).

CPT 23532: Open Repair of Sternoclavicular Dislocation with Fascia Graft

CPT-23616-OPEN-TREATMENT-PROXIMAL-HUMERUS-NECK-FRACTURE

CPT 23616: Open Treatment of Proximal Humerus Neck Fracture

CPT-23550-ACROMIOCLAVICULAR-DISLOCATION-OPEN-FIXATION

CPT 23550: Open Fixation of Acromioclavicular Dislocation

CPT-23665-CLOSED-TREATMENT-SHOULDER-DISLOCATION-GREATER-TUBEROSITY-REDUCTION-MANIPULATION

CPT 23665: Closed Treatment of Shoulder Dislocation with Greater Tuberosity Reduction

CPT-23675-CLOSED-REDUCTION-SHOULDER-DISLOCATION-PROXIMAL-HUMERUS-FRACTURE

CPT 23675: Closed Reduction of Shoulder Dislocation with Proximal Humerus Fracture

CPT-23552-ACROMIOCLAVICULAR-DISLOCATION-OPEN-RECONSTRUCTION-FASCIA-GRAFT

CPT 23552: Open Reconstruction for Acromioclavicular Dislocation with Fascia Graft

CPT-23605-CLOSED-TREATMENT-HUMERUS-SURGICAL-NECK-FRACTURE

CPT 23605: Closed Treatment of Surgical/Anatomical Neck Fracture of Humerus

CPT-23515-CLAVICLE-FRACTURE-OPEN-FIXATION

CPT 23515: Open Treatment of Clavicle Fracture

CPT-23530-STERNOCLAVICULAR-DISLOCATION-OPEN-FIXATION

CPT 23530: Open Repair, Sternoclavicular Dislocation with Internal Fixation

CPT-23630-GREATER-HUMERAL-TUBEROSITY-FRACTURE-FIXATION

CPT 23630: Open Fixation of Greater Humeral Tuberosity Fracture

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Taxonomy Code	Specialty	Notes
207X00000X	Orthopaedic Surgery	Primary specialty performing open shoulder reduction and proximal humerus fracture repair.
2080P0208X	General Surgery (Trauma)	Trauma/general surgeons may perform open reduction and fixation in trauma centers.
366A00000X	Anesthesiology	Provides general or regional anesthesia; essential to operative care.
207L00000X	Hand Surgery	May be involved when proximal humerus fractures have complex distal implications; less common but relevant.
1835P0206X	Physical Therapist	Provides postoperative rehabilitation; included as provider taxonomy although not a surgical coder.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S43.01XA`	Anterior dislocation of right shoulder, initial encounter	Common presentation leading to open reduction when closed reduction fails or is contraindicated.
`S43.02XA`	Posterior dislocation of right shoulder, initial encounter	Less common direction of dislocation; may require open treatment if complex or associated with fracture.
`S42.21XA`	Fracture of surgical neck of right humerus, initial encounter for closed fracture	Directly matches the fracture component repaired during this procedure.
`S42.20XA`	Fracture of surgical neck of unspecified humerus, initial encounter	Used when laterality is not specified at initial documentation.
`S42.201A`	Unspecified fracture of surgical neck of right humerus, initial encounter for closed fracture	Used when documentation does not clearly define displacement; aligns with repair of surgical neck fractures.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`23685`	Closed treatment of shoulder dislocation; with anesthesia, manipulation, without arthroplasty, may include local anesthesia and/or sedation	May be attempted prior to open treatment; if closed reduction succeeds, `23680` would not be reported.
`24030`	Open treatment of humeral shaft fracture, includes internal fixation, when performed	Performed when fracture extends into the humeral shaft or requires additional fixation distal to the surgical neck.
`20680`	Removal of implant; deep (e.g., plate, screw), requiring major exposure	May be performed later if hardware causes pain, infection, or implant failure after `23680`.
`73030`	Radiologic examination, shoulder; complete, minimum of two views	Preoperative and postoperative radiographs to document dislocation and fixation alignment.
`29999`	Unlisted procedure, arthroscopy	Used rarely if arthroscopic assistance or atypical procedures accompany open repair and no specific code exists; typically avoid when specific codes apply.

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