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CPT code 23500: Clavicle fracture care, without manipulation2026 Medicare rate & RVUs in Puerto Rico

Reports nonoperative definitive care of a clavicle fracture when the clinician treats it without manipulating or manually repositioning the fracture fragments.

CMS RVU26DEffective Oct 1, 2026One payment locality10.8K Medicare services in 2024

In Puerto Rico, Medicare pays $259.85 for 23500 in the office and $246.68 when it’s performed in a hospital or facility.

$259.85Office (non-facility)
$246.68Hospital or facility
+0.6%vs the national office rate ($258.19)

Check a contract rate as a % of Medicare · 23500 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 23500 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 23500 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 23500 covers

This service covers nonoperative management of a clavicle fracture without manually repositioning the fragments. Care may include assessing alignment, choosing support such as a sling, and providing activity restrictions and follow-up instructions. Orthopedic clinicians commonly provide the treatment in an outpatient clinic or emergency setting, or after referral from another clinician.

Report 23500 when the record supports definitive closed fracture care without manipulation, rather than evaluation alone. Document the affected clavicle, fracture diagnosis, treatment undertaken, and plan for immobilization and monitoring. The CMS global period includes the day-before preoperative visit and 90 days of related postoperative care. For procedures performed in the same session, the highest-valued procedure is paid in full and others at 50%. Bilateral treatment reported with modifier 50 is paid at 150%. Assistant-at-surgery services are not paid; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Puerto Rico compares for 23500

Across 109 of 109 payment localities, the office rate for 23500 runs from $226.74 in Arkansas to $334.85 in San Benito County, CA. Puerto Rico pays $259.85. The RVUs are the same everywhere; the geographic indexes change the dollars.

23500 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$259.85
  2. Los Angeles, CA · California$287.44+$27.59
  3. Washington, DC area · District of Columbia$294.26+$34.41
  4. Miami, FL · Florida$288.20+$28.35
  5. Chicago, IL · Illinois$279.01+$19.16
  6. Manhattan, NY · New York$299.35+$39.50
  7. Alaska · Alaska$298.48+$38.63

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

23500 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$230.25$218.85
ArkansasArkansas$226.74$215.55
ArizonaArizona$250.71$238.09
Bakersfield, CACalifornia$270.13$255.85
Chico, CACalifornia$268.88$254.61
El Centro, CACalifornia$268.96$254.68
Fresno, CACalifornia$268.88$254.61
Hanford, CACalifornia$268.88$254.61

23500 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$226.74

$301.87

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
23500 office rate range by state
State / territoryOffice rate rangeLocalities
AK$298.481
AL$230.251
AR$226.741
AZ$250.711
CA$268.88–$334.8529
CO$266.731
CT$275.981
DC$294.261
DE$254.971
FL$258.21–$288.203
GA$242.57–$264.172
GU$275.341
HI$275.341
IA$234.561
ID$236.561
IL$251.74–$279.014
IN$237.961
KS$234.281
KY$237.891
LA$237.85–$250.122
MA$265.37–$292.722
MD$259.73–$294.263
ME$238.80–$251.102
MI$245.22–$262.502
MN$252.581
MO$234.15–$249.993
MS$230.451
MT$258.161
NC$241.281
ND$249.261
NE$235.651
NH$263.341
NJ$278.28–$291.152
NM$246.991
NV$255.851
NY$245.16–$308.055
OH$243.401
OK$236.501
OR$253.04–$274.512
PA$243.31–$269.412
PR$259.851
RI$263.581
SC$242.911
SD$248.211
TN$235.641
TX$241.70–$266.568
UT$246.381
VA$250.86–$294.262
VI$259.851
VT$249.051
WA$264.61–$297.922
WI$240.591
WV$242.221
WY$254.281

See 23500 in every payment locality

How the 23500 rate is calculated

Each of 23500’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 23500

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.15

2.15 RVUs× 1.000 GPCI

Practice expense5.13

5.13 RVUs× 1.000 GPCI

Malpractice0.45

0.45 RVUs× 1.000 GPCI

Adjusted RVUs

7.7300

Conversion factor

$33.4009

Medicare rate

$258.19

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

2,218

Code
23500
Physician work
2.15
Practice expense
5.13
Malpractice
0.45

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 23500 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work2.15× 1.0002.1500
Practice expense5.13× 1.0115.1864
Malpractice0.45× 0.9850.4432
Total RVUs7.7797
Conversion factor× 33.4009

Office rate, Puerto Rico$259.85

Office: (2.15 × 1 + 5.13 × 1.011 + 0.45 × 0.985) × $33.4009 = $259.85

Facility: (2.15 × 1 + 4.74 × 1.011 + 0.45 × 0.985) × $33.4009 = $246.68

Open 23500 in the RVU calculator

Payment rules and modifiers for 23500

23500 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 23500

Clavicle fracture care, without manipulation

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 23500

Clavicle fracture care, without manipulation

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

23500 without 50 · national office

$258.19

Clavicle fracture care, without manipulation

23500-50 · Bilateral: 150%

$387.29

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

Codes related to 23500

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 23500
CodeHow it relatesOffice range, Puerto Rico
Same family
23505Clavicle fracture, with manipulationClosed clavicle fracture treatment involving manipulation.$411.25
Used instead
23515Clavicle fracture repair, open treatmentOperative clavicle fracture treatment with internal fixation.No office rate
Often billed with
73000Clavicle X-ray, at least two viewsClavicle radiographs may be obtained during fracture evaluation or treatment.$33.69

How 23500 has changed in Puerto Rico

23500 · Office / nonfacility

$259.85

Effective 2026-10-01

The base rate is $28.49 higher than on 2025-10-01, moving from $231.36 to $259.85 (12.3%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $231.36changed to$259.85

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.21 changed to 2.15
    • Practice expense RVU 4.45 changed to 5.13
    • Malpractice RVU 0.47 changed to 0.45
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $234.43changed to$231.36

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 4.37 changed to 4.45
    • Malpractice RVU 0.44 changed to 0.47

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $230.61changed to$234.43

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $234.74changed to$230.61

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.25 changed to 4.37
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $233.82changed to$234.74

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $232.44changed to$233.82

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.06 changed to 4.25
    • Malpractice RVU 0.42 changed to 0.44
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $231.19changed to$232.44

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 3.96 changed to 4.06
    • Malpractice RVU 0.43 changed to 0.42

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $228.96changed to$231.19

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.68 changed to 3.96
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $225.67changed to$228.96

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.65 changed to 3.68
    • Malpractice RVU 0.38 changed to 0.43
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $226.51changed to$225.67

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.69 changed to 3.65
    • Malpractice RVU 0.37 changed to 0.38

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $199.28changed to$226.51

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.62 changed to 3.69
    • Malpractice RVU 0.38 changed to 0.37
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $174.60changed to$199.28

    • Conversion factor 35.8043 changed to 35.8887
    • Malpractice RVU 0.39 changed to 0.38
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $174.87changed to$174.60

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 3.61 changed to 3.62
    • Malpractice RVU 0.38 changed to 0.39

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $174.00changed to$174.87

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $171.95changed to$174.00

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.59 changed to 3.61
    • Malpractice RVU 0.39 changed to 0.38
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $170.47changed to$171.95

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.98 changed to 3.59
    • Malpractice RVU 0.41 changed to 0.39
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $170.47

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$259.85$246.68RVU26D
2026-07-01$259.85$246.68RVU26C
2026-04-01$259.85$246.68RVU26B
2026-01-01$259.85$246.68RVU26A
2025-10-01$231.36$236.90RVU25D
2025-07-01$231.36$236.90RVU25C
2025-04-01$231.36$236.90RVU25B
2025-01-01$231.36$236.90RVU25A
2024-10-01$234.43$239.80RVU24D
2024-07-01$234.43$239.80RVU24C
2024-04-01$234.43$239.80RVU24B
2024-03-09$234.43$239.80RVU24AR
2024-01-01$230.61$235.88RVU24A
2023-10-01$234.74$239.86RVU23D
2023-07-01$233.82$238.90RVU23C
2023-04-01$233.82$238.90RVU23B
2023-01-01$233.82$238.90RVU23A
2022-10-01$232.44$237.32RVU22D
2022-07-01$232.44$237.32RVU22C
2022-04-01$232.44$237.32RVU22B
2022-01-01$232.44$237.32RVU22A
2021-10-01$231.19$235.76RVU21D
2021-07-01$231.19$235.76RVU21C
2021-04-01$231.19$235.76RVU21B
2021-01-01$231.19$235.76RVU21A
2020-10-01$228.96$233.69RVU20D
2020-07-01$228.96$233.69RVU20C
2020-04-01$228.96$233.69RVU20B
2020-01-01$228.96$233.69RVU20A
2019-10-01$225.67$230.39RVU19D
2019-07-01$225.67$230.39RVU19C
2019-04-01$225.67$230.39RVU19B
2019-01-01$225.67$230.39RVU19A
2018-10-01$226.51$229.05RVU18D
2018-07-01$226.51$229.05RVU18C
2018-04-01$226.51$229.05RVU18B
2018-01-01$226.51$229.05RVU18AR1
2017-10-01$199.28$202.35RVU17D
2017-07-01$199.28$202.35RVU17C
2017-04-01$199.28$202.35RVU17B
2017-01-01$199.28$202.35RVU17A
2016-10-01$174.60$177.37RVU16D
2016-07-01$174.60$177.37RVU16C
2016-04-01$174.60$177.37RVU16B
2016-01-01$174.60$177.37RVU16A
2015-10-01$174.87$177.40RVU15D
2015-07-01$174.87$177.40RVU15C
2015-04-01$174.00$176.52RVU15B
2015-01-01$174.00$176.52RVU15A
2014-10-01$171.95$174.43RVU14D
2014-07-01$171.95$174.43RVU14C
2014-04-01$171.95$174.43RVU14B
2014-01-01$171.95$174.43RVU14A
2013-10-01$170.47$173.01RVU13D
2013-07-01$170.47$173.01RVU13C
2013-04-01$170.47$173.01RVU13B
2013-01-01$170.47$173.01RVU13AR

Price 23500 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

23500 billing questions

When should 23500 be chosen over 23505?

Use 23500 when definitive closed care is provided without manipulating the fracture. Use 23505 when the clinician manipulates the fracture.

Can the evaluation visit be billed separately?

The CMS 90-day global period includes the day-before preoperative visit and related postoperative care. Do not separately report routine care included in that global period.

How is treatment of both clavicles reported?

When both sides are treated, modifier 50 identifies the bilateral procedure; CMS pays it at 150%.

Is an assistant surgeon payable for this service?

No. CMS lists a statutory restriction on assistant-at-surgery payment for this code.

What documentation supports reporting 23500?

Document the clavicle fracture, the side treated, and the definitive closed treatment performed without manipulation, along with the immobilization and follow-up plan.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 23500PPRRVU2026_Oct_nonQPP.csv, line 2,218 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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