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CPT code 23540: AC joint dislocation, without manipulation2026 Medicare rate & RVUs in North Carolina

Reports nonoperative treatment of an acromioclavicular joint dislocation when the physician treats the injury without manipulating the joint.

CMS RVU26DEffective Oct 1, 2026One payment locality246 Medicare services in 2024

In North Carolina, Medicare pays $258.37 for 23540 in the office and $239.98 when it’s performed in a hospital or facility.

$258.37Office (non-facility)
$239.98Hospital or facility
−6.6%vs the national office rate ($276.56)

Check a contract rate as a % of Medicare · 23540 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 23540 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 23540 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 23540 covers

This service covers definitive nonoperative care for an acromioclavicular (AC) joint dislocation, the separation between the distal clavicle and the acromion. An orthopedic surgeon or other qualified physician may manage a traumatic AC separation with measures such as immobilization and a treatment plan that avoids joint manipulation. The code is specific to the AC joint, not a sternoclavicular dislocation or a clavicle fracture.

Report it when the physician assumes treatment of the dislocation without manipulating it; documentation should identify the injury and side, the treatment decision, and the nonoperative plan. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For bilateral treatment reported with modifier 50, CMS pays at 150%. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Medicare does not pay an assistant at surgery for this code; 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 North Carolina compares for 23540

Across 109 of 109 payment localities, the office rate for 23540 runs from $242.77 in Arkansas to $358.47 in San Benito County, CA. North Carolina pays $258.37. The RVUs are the same everywhere; the geographic indexes change the dollars.

23540 in North Carolina vs other payment areas
  1. North Carolina · this page$258.37
  2. Los Angeles, CA · California$307.77+$49.40
  3. Washington, DC area · District of Columbia$315.20+$56.83
  4. Miami, FL · Florida$309.10+$50.73
  5. Chicago, IL · Illinois$299.21+$40.84
  6. Manhattan, NY · New York$320.77+$62.40
  7. Alaska · Alaska$319.54+$61.17

Other areas in North Carolina first, then benchmark localities. Bars start at $0.

Every other payment area

23540 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$246.54$229.29
ArkansasArkansas$242.77$225.84
ArizonaArizona$268.52$249.42
Bakersfield, CACalifornia$289.22$267.63
Chico, CACalifornia$287.88$266.28
El Centro, CACalifornia$287.96$266.36
Fresno, CACalifornia$287.88$266.28
Hanford, CACalifornia$287.88$266.28

23540 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.

$242.77

$323.18

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

View every state and territory as a table
23540 office rate range by state
State / territoryOffice rate rangeLocalities
AK$319.541
AL$246.541
AR$242.771
AZ$268.521
CA$287.88–$358.4729
CO$285.631
CT$295.651
DC$315.201
DE$273.091
FL$276.72–$309.103
GA$259.90–$283.012
GU$294.791
HI$294.791
IA$251.101
ID$253.261
IL$269.82–$299.214
IN$254.761
KS$250.841
KY$254.811
LA$254.78–$267.972
MA$284.18–$313.482
MD$278.19–$315.203
ME$255.70–$268.872
MI$262.72–$281.372
MN$270.361
MO$250.83–$267.793
MS$246.801
MT$276.531
NC$258.371
ND$266.841
NE$252.261
NH$282.031
NJ$298.09–$311.852
NM$264.631
NV$274.011
NY$262.53–$330.165
OH$260.741
OK$253.291
OR$270.97–$293.952
PA$260.62–$288.622
PR$278.331
RI$282.301
SC$260.171
SD$265.691
TN$252.301
TX$258.89–$285.488
UT$263.891
VA$268.63–$315.202
VI$278.331
VT$266.641
WA$283.37–$319.032
WI$257.531
WV$259.591
WY$272.301

See 23540 in every payment locality

How the 23540 rate is calculated

Each of 23540’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 · 23540

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.30

2.30 RVUs× 1.000 GPCI

Practice expense5.49

5.49 RVUs× 1.000 GPCI

Malpractice0.49

0.49 RVUs× 1.000 GPCI

Adjusted RVUs

8.2800

Conversion factor

$33.4009

Medicare rate

$276.56

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

The exact North Carolina inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

2,225

Code
23540
Physician work
2.30
Practice expense
5.49
Malpractice
0.49

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 23540 in North Carolina
ComponentRVULocality factorAdjusted
Physician work2.30× 1.0002.3000
Practice expense5.49× 0.9335.1222
Malpractice0.49× 0.6390.3131
Total RVUs7.7353
Conversion factor× 33.4009

Office rate, North Carolina$258.37

Office: (2.3 × 1 + 5.49 × 0.933 + 0.49 × 0.639) × $33.4009 = $258.37

Facility: (2.3 × 1 + 4.9 × 0.933 + 0.49 × 0.639) × $33.4009 = $239.98

Open 23540 in the RVU calculator

Payment rules and modifiers for 23540

23540 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 23540

AC joint dislocation, 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 · 23540

AC joint dislocation, 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

23540 without 50 · national office

$276.56

AC joint dislocation, without manipulation

23540-50 · Bilateral: 150%

$414.84

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 23540

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

Codes related to 23540
CodeHow it relatesOffice range, North Carolina
Same family
23545AC joint treatment, closed, with manipulationClosed treatment of an AC dislocation when manipulation is performed.$467.70
Used instead
23550AC joint repair, open treatment without graftOpen treatment option for an AC dislocation.No office rate
23552AC joint reconstruction, with graftOpen AC dislocation treatment involving graft reconstruction.No office rate

How 23540 has changed in North Carolina

23540 · Office / nonfacility

$258.37

Effective 2026-10-01

The base rate is $31.01 higher than on 2025-10-01, moving from $227.36 to $258.37 (13.6%).

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

    $227.36changed to$258.37

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.36 changed to 2.30
    • Practice expense RVU 4.69 changed to 5.49
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $232.60changed to$227.36

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 4.66 changed to 4.69
    • Malpractice RVU 0.47 changed to 0.49

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $228.81changed to$232.60

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $235.10changed to$228.81

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.57 changed to 4.66
    • Malpractice RVU 0.46 changed to 0.47
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $235.01changed to$235.10

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.36 changed to 4.57
    • Malpractice RVU 0.47 changed to 0.46
    • Practice expense GPCI 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $231.17changed to$235.01

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 4.19 changed to 4.36
    • Malpractice RVU 0.46 changed to 0.47

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $226.96changed to$231.17

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.85 changed to 4.19
    • Practice expense GPCI 0.930 changed to 0.928
    • Malpractice GPCI 0.757 changed to 0.819

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $221.90changed to$226.96

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.78 changed to 3.85
    • Malpractice RVU 0.40 changed to 0.46
    • Practice expense GPCI 0.931 changed to 0.930
    • Malpractice GPCI 0.695 changed to 0.757

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $218.72changed to$221.90

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.70 changed to 3.78
    • Malpractice RVU 0.39 changed to 0.40

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $215.90changed to$218.72

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.62 changed to 3.70
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $216.37changed to$215.90

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 3.63 changed to 3.62
    • Malpractice RVU 0.40 changed to 0.39
    • Practice expense GPCI 0.930 changed to 0.931
    • Malpractice GPCI 0.768 changed to 0.732

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $217.76changed to$216.37

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 3.64 changed to 3.63
    • Malpractice RVU 0.41 changed to 0.40

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $216.68changed to$217.76

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $214.17changed to$216.68

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.58 changed to 3.64
    • Malpractice RVU 0.40 changed to 0.41
    • Practice expense GPCI 0.929 changed to 0.930
    • Malpractice GPCI 0.732 changed to 0.768

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $215.44changed to$214.17

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.97 changed to 3.58
    • Malpractice RVU 0.42 changed to 0.40
    • Practice expense GPCI 0.927 changed to 0.929
    • Malpractice GPCI 0.695 changed to 0.732

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $215.44

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$258.37$239.98RVU26D
2026-07-01$258.37$239.98RVU26C
2026-04-01$258.37$239.98RVU26B
2026-01-01$258.37$239.98RVU26A
2025-10-01$227.36$225.86RVU25D
2025-07-01$227.36$225.86RVU25C
2025-04-01$227.36$225.86RVU25B
2025-01-01$227.36$225.86RVU25A
2024-10-01$232.60$230.75RVU24D
2024-07-01$232.60$230.75RVU24C
2024-04-01$232.60$230.75RVU24B
2024-03-09$232.60$230.75RVU24AR
2024-01-01$228.81$226.99RVU24A
2023-10-01$235.10$232.27RVU23D
2023-07-01$235.10$232.27RVU23C
2023-04-01$235.10$232.27RVU23B
2023-01-01$235.10$232.27RVU23A
2022-10-01$235.01$231.48RVU22D
2022-07-01$235.01$231.48RVU22C
2022-04-01$235.01$231.48RVU22B
2022-01-01$235.01$231.48RVU22A
2021-10-01$231.17$228.58RVU21D
2021-07-01$231.17$228.58RVU21C
2021-04-01$231.17$228.58RVU21B
2021-01-01$231.17$228.58RVU21A
2020-10-01$226.96$225.95RVU20D
2020-07-01$226.96$225.95RVU20C
2020-04-01$226.96$225.95RVU20B
2020-01-01$226.96$225.95RVU20A
2019-10-01$221.90$222.57RVU19D
2019-07-01$221.90$222.57RVU19C
2019-04-01$221.90$222.57RVU19B
2019-01-01$221.90$222.57RVU19A
2018-10-01$218.72$221.07RVU18D
2018-07-01$218.72$221.07RVU18C
2018-04-01$218.72$221.07RVU18B
2018-01-01$218.72$221.07RVU18AR1
2017-10-01$215.90$219.24RVU17D
2017-07-01$215.90$219.24RVU17C
2017-04-01$215.90$219.24RVU17B
2017-01-01$215.90$219.24RVU17A
2016-10-01$216.37$220.03RVU16D
2016-07-01$216.37$220.03RVU16C
2016-04-01$216.37$220.03RVU16B
2016-01-01$216.37$220.03RVU16A
2015-10-01$217.76$221.10RVU15D
2015-07-01$217.76$221.10RVU15C
2015-04-01$216.68$220.00RVU15B
2015-01-01$216.68$220.00RVU15A
2014-10-01$214.17$217.50RVU14D
2014-07-01$214.17$217.50RVU14C
2014-04-01$214.17$217.50RVU14B
2014-01-01$214.17$217.50RVU14A
2013-10-01$215.44$219.22RVU13D
2013-07-01$215.44$219.22RVU13C
2013-04-01$215.44$219.22RVU13B
2013-01-01$215.44$219.22RVU13AR

Price 23540 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Advance
  • Ahoskie
  • Alamance
  • Albemarle
  • Alexis
  • Alliance
  • Altamahaw

Browse all communities in North Carolina

23540 billing questions

How is this code different from 23545?

Use 23540 when the AC dislocation is treated without manipulating the joint. Code 23545 is the corresponding closed-treatment option when manipulation is performed.

Does the global period include follow-up care?

Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

How is bilateral treatment reported?

For treatment of both AC joints, report modifier 50. CMS pays bilateral reporting at 150%.

Can an assistant or co-surgeon be reported?

Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.

What happens when another procedure is performed in the same session?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.

What documentation supports reporting this service?

Document the AC joint dislocation, the affected side, the decision to manage it nonoperatively, and that the joint was not manipulated.

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 23540PPRRVU2026_Oct_nonQPP.csv, line 2,225 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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