FeeBase
Log inGet started
Menu

CPT code 23545: AC joint treatment, closed, with manipulation2026 Medicare rate & RVUs in Puerto Rico

Reports physician-performed closed reduction of an acromioclavicular joint dislocation when manipulation is used, rather than treatment without manipulation or open reconstruction.

CMS RVU26DEffective Oct 1, 2026One payment locality80 Medicare services in 2024

In Puerto Rico, Medicare pays $505.59 for 23545 in the office and $428.94 when it’s performed in a hospital or facility.

$505.59Office (non-facility)
$428.94Hospital or facility
+0.7%vs the national office rate ($502.02)

Check a contract rate as a % of Medicare · 23545 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 23545 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 23545 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 23545 covers

This service treats a dislocation of the acromioclavicular joint, where the clavicle meets the acromion, by manipulating the joint to restore alignment without open repair. An orthopedic surgeon commonly performs it in an acute-care or surgical setting. The patient may then be immobilized, for example in a sling, as part of the treatment plan.

Choose this code when the physician performs manipulation as part of closed treatment; treatment without manipulation is represented by a different code. Document the dislocation, the side, the manipulation and reduction performed, and the resulting treatment plan. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued is paid in full and the others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; 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 23545

Across 109 of 109 payment localities, the office rate for 23545 runs from $437.42 in Arkansas to $661.75 in San Benito County, CA. Puerto Rico pays $505.59. The RVUs are the same everywhere; the geographic indexes change the dollars.

23545 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$505.59
  2. Los Angeles, CA · California$563.65+$58.06
  3. Washington, DC area · District of Columbia$575.74+$70.15
  4. Miami, FL · Florida$559.28+$53.69
  5. Chicago, IL · Illinois$540.51+$34.92
  6. Manhattan, NY · New York$584.16+$78.57
  7. Alaska · Alaska$568.93+$63.34

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

Every other payment area

23545 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$444.64$378.30
ArkansasArkansas$437.42$372.30
ArizonaArizona$486.78$413.31
Bakersfield, CACalifornia$528.12$445.02
Chico, CACalifornia$525.87$442.77
El Centro, CACalifornia$526.01$442.91
Fresno, CACalifornia$525.87$442.77
Hanford, CACalifornia$525.87$442.77

23545 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.

$437.42

$593.81

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

View every state and territory as a table
23545 office rate range by state
State / territoryOffice rate rangeLocalities
AK$568.931
AL$444.641
AR$437.421
AZ$486.781
CA$525.87–$661.7529
CO$520.501
CT$538.001
DC$575.741
DE$495.421
FL$500.00–$559.283
GA$468.16–$513.732
GU$540.041
HI$540.041
IA$454.471
ID$458.391
IL$486.07–$540.514
IN$461.291
KS$453.441
KY$459.401
LA$459.14–$484.382
MA$517.40–$573.912
MD$505.21–$575.743
ME$462.52–$488.522
MI$474.03–$508.342
MN$493.021
MO$451.24–$484.663
MS$444.361
MT$501.961
NC$467.701
ND$485.551
NE$456.841
NH$513.421
NJ$542.54–$568.972
NM$477.481
NV$497.751
NY$475.65–$601.475
OH$470.681
OK$457.021
OR$492.33–$536.972
PA$470.75–$524.252
PR$505.591
RI$513.111
SC$470.291
SD$483.611
TN$456.171
TX$467.40–$520.128
UT$477.421
VA$487.70–$575.742
VI$505.591
VT$484.691
WA$516.06–$584.862
WI$467.601
WV$466.451
WY$494.811

See 23545 in every payment locality

How the 23545 rate is calculated

Each of 23545’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 · 23545

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.34

3.34 RVUs× 1.000 GPCI

Practice expense10.86

10.86 RVUs× 1.000 GPCI

Malpractice0.83

0.83 RVUs× 1.000 GPCI

Adjusted RVUs

15.0300

Conversion factor

$33.4009

Medicare rate

$502.02

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

2,226

Code
23545
Physician work
3.34
Practice expense
10.86
Malpractice
0.83

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 23545 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work3.34× 1.0003.3400
Practice expense10.86× 1.01110.9795
Malpractice0.83× 0.9850.8175
Total RVUs15.1370
Conversion factor× 33.4009

Office rate, Puerto Rico$505.59

Office: (3.34 × 1 + 10.86 × 1.011 + 0.83 × 0.985) × $33.4009 = $505.59

Facility: (3.34 × 1 + 8.59 × 1.011 + 0.83 × 0.985) × $33.4009 = $428.94

Open 23545 in the RVU calculator

Payment rules and modifiers for 23545

23545 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 23545

AC joint treatment, closed, with 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)0Not paid without supporting documentation.
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 · 23545

AC joint treatment, closed, with 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

23545 without 50 · national office

$502.02

AC joint treatment, closed, with manipulation

23545-50 · Bilateral: 150%

$753.03

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 23545

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

Codes related to 23545
CodeHow it relatesOffice range, Puerto Rico
Same family
23540AC joint dislocation, without manipulationClosed treatment of an AC dislocation without manipulation.$278.33
Used instead
23550AC joint repair, open treatment without graftOpen treatment of an AC dislocation without the graft distinction.No office rate
23552AC joint reconstruction, with graftOpen treatment of an AC dislocation with a graft.No office rate

How 23545 has changed in Puerto Rico

23545 · Office / nonfacility

$505.59

Effective 2026-10-01

The base rate is $134.64 higher than on 2025-10-01, moving from $370.95 to $505.59 (36.3%).

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

    $370.95changed to$505.59

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.43 changed to 3.34
    • Practice expense RVU 7.28 changed to 10.86
    • Malpractice RVU 0.72 changed to 0.83
    • 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

    $377.37changed to$370.95

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 7.13 changed to 7.28
    • Malpractice RVU 0.74 changed to 0.72

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $371.21changed to$377.37

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $376.96changed to$371.21

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 6.93 changed to 7.13
    • Malpractice RVU 0.72 changed to 0.74
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $375.47changed to$376.96

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

  6. January 1, 2023

    RVU23A

    $367.56changed to$375.47

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 6.42 changed to 6.93
    • Malpractice RVU 0.73 changed to 0.72
    • 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

    $360.77changed to$367.56

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 6.16 changed to 6.42
    • Malpractice RVU 0.71 changed to 0.73

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $357.21changed to$360.77

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.75 changed to 6.16
    • Malpractice RVU 0.68 changed to 0.71
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $358.45changed to$357.21

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 5.94 changed to 5.75
    • Malpractice RVU 0.54 changed to 0.68
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. July 1, 2019

    RVU19C

    $357.74changed to$358.45

    • Malpractice RVU 0.52 changed to 0.54

    Held through RVU19D.

  11. January 1, 2019

    RVU19A

    $354.06changed to$357.74

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 5.82 changed to 5.94
    • Malpractice RVU 0.55 changed to 0.52

    Held through RVU19B.

  12. January 1, 2018

    RVU18AR1

    $307.58changed to$354.06

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 5.60 changed to 5.82
    • Malpractice RVU 0.54 changed to 0.55
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  13. January 1, 2017

    RVU17A

    $272.35changed to$307.58

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 5.70 changed to 5.60
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  14. January 1, 2016

    RVU16A

    $273.50changed to$272.35

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 5.69 changed to 5.70
    • Malpractice RVU 0.58 changed to 0.54

    Held through RVU16B, RVU16C, RVU16D.

  15. July 1, 2015

    RVU15C

    $272.14changed to$273.50

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  16. January 1, 2015

    RVU15A

    $267.97changed to$272.14

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 5.63 changed to 5.69
    • Malpractice RVU 0.57 changed to 0.58
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  17. January 1, 2014

    RVU14A

    $270.57changed to$267.97

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 6.45 changed to 5.63
    • Malpractice RVU 0.60 changed to 0.57
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  18. January 1, 2013

    RVU13AR

    Earliest loaded release: $270.57

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$505.59$428.94RVU26D
2026-07-01$505.59$428.94RVU26C
2026-04-01$505.59$428.94RVU26B
2026-01-01$505.59$428.94RVU26A
2025-10-01$370.95$332.19RVU25D
2025-07-01$370.95$332.19RVU25C
2025-04-01$370.95$332.19RVU25B
2025-01-01$370.95$332.19RVU25A
2024-10-01$377.37$338.15RVU24D
2024-07-01$377.37$338.15RVU24C
2024-04-01$377.37$338.15RVU24B
2024-03-09$377.37$338.15RVU24AR
2024-01-01$371.21$332.63RVU24A
2023-10-01$376.96$337.68RVU23D
2023-07-01$375.47$336.50RVU23C
2023-04-01$375.47$336.50RVU23B
2023-01-01$375.47$336.50RVU23A
2022-10-01$367.56$329.88RVU22D
2022-07-01$367.56$329.88RVU22C
2022-04-01$367.56$329.88RVU22B
2022-01-01$367.56$329.88RVU22A
2021-10-01$360.77$324.54RVU21D
2021-07-01$360.77$324.54RVU21C
2021-04-01$360.77$324.54RVU21B
2021-01-01$360.77$324.54RVU21A
2020-10-01$357.21$323.01RVU20D
2020-07-01$357.21$323.01RVU20C
2020-04-01$357.21$323.01RVU20B
2020-01-01$357.21$323.01RVU20A
2019-10-01$358.45$322.89RVU19D
2019-07-01$358.45$322.89RVU19C
2019-04-01$357.74$322.17RVU19B
2019-01-01$357.74$322.17RVU19A
2018-10-01$354.06$320.35RVU18D
2018-07-01$354.06$320.35RVU18C
2018-04-01$354.06$320.35RVU18B
2018-01-01$354.06$320.35RVU18AR1
2017-10-01$307.58$281.46RVU17D
2017-07-01$307.58$281.46RVU17C
2017-04-01$307.58$281.46RVU17B
2017-01-01$307.58$281.46RVU17A
2016-10-01$272.35$250.39RVU16D
2016-07-01$272.35$250.39RVU16C
2016-04-01$272.35$250.39RVU16B
2016-01-01$272.35$250.39RVU16A
2015-10-01$273.50$250.96RVU15D
2015-07-01$273.50$250.96RVU15C
2015-04-01$272.14$249.71RVU15B
2015-01-01$272.14$249.71RVU15A
2014-10-01$267.97$246.65RVU14D
2014-07-01$267.97$246.65RVU14C
2014-04-01$267.97$246.65RVU14B
2014-01-01$267.97$246.65RVU14A
2013-10-01$270.57$247.50RVU13D
2013-07-01$270.57$247.50RVU13C
2013-04-01$270.57$247.50RVU13B
2013-01-01$270.57$247.50RVU13AR

Price 23545 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

23545 billing questions

How does this differ from 23540?

Use 23545 when manipulation is performed as part of closed treatment of the AC dislocation. Code 23540 represents closed treatment without manipulation.

When would an open-treatment code be more appropriate?

Use an open-treatment code when the surgeon treats the AC dislocation through an open approach, rather than by closed manipulation. Code 23550 covers open treatment without the graft distinction found in 23552.

What documentation supports reporting this code?

Document the AC dislocation, laterality, the manipulation performed to reduce it, and the post-treatment plan. The record should make clear that manipulation was part of the closed treatment.

How is bilateral treatment handled?

For bilateral procedures, CMS specifies modifier 50 and payment at 150%. Document the treatment performed on each side.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. Related routine follow-up during that period is included in the global service.

Can an assistant surgeon or co-surgeon be reported?

Assistant-at-surgery payment is allowed only when medical necessity is documented. CMS does not permit co-surgeons or team surgery for this code.

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 23545PPRRVU2026_Oct_nonQPP.csv, line 2,226 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 23545 pays in Puerto Rico?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets · Coming soon

Put 23545 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Join the waitlist