Billing code 23665: Shoulder reductionMedicare rate & RVUs
Reports closed manipulation of a shoulder dislocation accompanied by a greater tuberosity fracture, with closed treatment of the fracture included.
Medicare pays $498.34 for 23665 nationally in the office and $416.51 in a hospital or facility. Local office rates run $437.97–$638.00.
Medicare rate · 23665
Shoulder reduction
Swap in your local Medicare rate.
- Work RVUs
- 4.54
- Total RVUs
- 14.92
- Global days
- 090
National rate · 2026
$498.34
Office setting, before claim adjustments.
See every locality for 23665 → · Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 10 sections
What 23665 covers
This code describes closed treatment of a shoulder dislocation when the injury also includes a fracture of the greater tuberosity of the humerus. The physician manipulates the shoulder to restore alignment and treats the associated fracture without open surgery. Orthopedic surgeons commonly provide this service after an acute injury, such as a fall or sports-related trauma, in an emergency department or operating room setting.
Report the code when documentation supports both the shoulder dislocation and greater tuberosity fracture, along with closed treatment involving manipulation. Treatment of the fracture is included; do not separately report a second closed-treatment service for that fracture. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care for 90 days. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures at 50%. For bilateral procedures, modifier 50 is paid at 150%. Assistant-at-surgery payment is statutorily restricted; 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.
Where 23665 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$437.97 to $638.00
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $444.68 | $373.08 |
| Alaska* | $579.53 | $492.38 |
| Arizona | $483.82 | $404.52 |
| Arkansas | $437.97 | $367.67 |
| Atlanta | $510.52 | $427.38 |
| Austin | $513.01 | $426.43 |
| Bakersfield | $518.24 | $428.55 |
| Baltimore/Surr. Cntys | $531.55 | $443.75 |
| Beaumont | $467.77 | $393.31 |
| Brazoria | $489.39 | $408.29 |
| Chicago | $544.22 | $461.98 |
| Chico | $515.50 | $425.81 |
| Colorado | $512.90 | $425.83 |
| Connecticut | $532.51 | $444.38 |
| Dallas | $493.71 | $412.21 |
| Dc + Md/Va Suburbs | $566.07 | $469.67 |
| Delaware | $491.97 | $411.12 |
| Detroit | $510.29 | $431.32 |
| East St. Louis | $507.15 | $431.86 |
| El Centro | $515.67 | $425.98 |
| Fort Lauderdale | $529.40 | $446.51 |
| Fort Worth | $491.01 | $410.32 |
| Fresno | $515.50 | $425.81 |
| Galveston | $491.62 | $410.36 |
| Hanford-Corcoran | $515.50 | $425.81 |
| Hawaii, Guam | $527.20 | $434.16 |
| Houston | $509.92 | $428.66 |
| Idaho | $455.68 | $380.39 |
| Indiana | $458.30 | $382.44 |
| Iowa | $451.57 | $376.69 |
| Kansas | $451.70 | $377.72 |
| Kentucky | $460.73 | $387.98 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $550.67 | $453.86 |
| Madera | $515.50 | $425.81 |
| Manhattan | $578.37 | $483.28 |
| Merced | $515.50 | $425.81 |
| Metropolitan Boston | $561.66 | $463.96 |
| Metropolitan Kansas City | $478.46 | $401.62 |
| Metropolitan Philadelphia | $520.36 | $435.18 |
| Metropolitan St. Louis | $483.37 | $405.47 |
| Miami | $562.26 | $477.07 |
| Minnesota | $483.91 | $399.71 |
| Mississippi | $446.08 | $375.62 |
| Modesto | $515.50 | $425.81 |
| Montana** | $498.27 | $416.44 |
| Napa | $591.09 | $483.24 |
| Nebraska | $453.44 | $377.91 |
| Nevada** | $493.08 | $411.16 |
| New Hampshire | $507.01 | $421.82 |
| New Mexico | $479.05 | $404.01 |
| New Orleans | $484.40 | $407.40 |
| North Carolina | $465.29 | $388.94 |
| North Dakota** | $478.50 | $396.67 |
| Northern Nj | $560.29 | $465.37 |
| Nyc Suburbs/Long Island | $595.88 | $498.59 |
| Ohio | $471.35 | $396.64 |
| Oklahoma | $457.37 | $384.29 |
| Oxnard-Thousand Oaks-Ventura | $547.02 | $450.29 |
| Portland | $526.99 | $436.08 |
| Poughkpsie/N Nyc Suburbs | $541.94 | $452.34 |
| Puerto Rico | $501.29 | $418.55 |
| Queens | $579.83 | $483.10 |
| Redding | $515.50 | $425.81 |
| Rest Of California | $515.50 | $425.81 |
| Rest Of Florida | $501.36 | $423.13 |
| Rest Of Georgia | $470.92 | $397.92 |
| Rest Of Illinois | $489.89 | $415.18 |
| Rest Of Louisiana | $460.91 | $388.49 |
| Rest Of Maine | $460.65 | $385.37 |
| Rest Of Maryland | $500.88 | $418.06 |
| Rest Of Massachusetts | $510.59 | $424.42 |
| Rest Of Michigan | $475.39 | $400.68 |
| Rest Of Missouri | $454.24 | $383.70 |
| Rest Of New Jersey | $536.47 | $447.11 |
| Rest Of New York | $472.76 | $395.02 |
| Rest Of Oregon | $487.17 | $405.66 |
| Rest Of Pennsylvania | $470.81 | $395.69 |
| Rest Of Texas | $479.12 | $401.46 |
| Rest Of Washington | $508.93 | $422.77 |
| Rhode Island | $507.95 | $423.42 |
| Riverside-San Bernardino-Ontario | $526.24 | $436.55 |
| Sacramento-Roseville-Folsom | $539.37 | $444.20 |
| Salinas | $537.36 | $442.52 |
| San Diego-Chula Vista-Carlsbad | $549.00 | $451.13 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $623.13 | $507.75 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $621.99 | $506.61 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $638.00 | $520.00 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $633.36 | $515.36 |
| San Luis Obispo-Paso Robles | $528.97 | $435.76 |
| Santa Cruz-Watsonville | $553.39 | $453.96 |
| Santa Maria-Santa Barbara | $539.10 | $443.68 |
| Santa Rosa-Petaluma | $558.83 | $458.34 |
| Seattle (King Cnty) | $570.93 | $470.52 |
| South Carolina | $469.52 | $393.91 |
| South Dakota** | $476.16 | $394.33 |
| Southern Maine | $483.20 | $402.10 |
| Stockton | $515.50 | $425.81 |
| Suburban Chicago | $533.65 | $449.61 |
| Tennessee | $454.37 | $379.98 |
| Utah | $476.14 | $399.21 |
| Vallejo | $589.45 | $481.60 |
| Vermont | $478.71 | $397.69 |
| Virgin Islands | $501.29 | $418.55 |
| Virginia | $483.20 | $402.75 |
| Visalia | $515.50 | $425.81 |
| West Virginia | $471.69 | $400.58 |
| Wisconsin | $462.07 | $383.67 |
| Wyoming** | $489.66 | $407.82 |
| Yuba City | $515.50 | $425.81 |
23665 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$437.97
$579.53
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $579.53 | 1 |
| AL | $444.68 | 1 |
| AR | $437.97 | 1 |
| AZ | $483.82 | 1 |
| CA | $515.50–$638.00 | 29 |
| CO | $512.90 | 1 |
| CT | $532.51 | 1 |
| DC | $566.07 | 1 |
| DE | $491.97 | 1 |
| FL | $501.36–$562.26 | 3 |
| GA | $470.92–$510.52 | 2 |
| GU | $527.20 | 1 |
| HI | $527.20 | 1 |
| IA | $451.57 | 1 |
| ID | $455.68 | 1 |
| IL | $489.89–$544.22 | 4 |
| IN | $458.30 | 1 |
| KS | $451.70 | 1 |
| KY | $460.73 | 1 |
| LA | $460.91–$484.40 | 2 |
| MA | $510.59–$561.66 | 2 |
| MD | $500.88–$566.07 | 3 |
| ME | $460.65–$483.20 | 2 |
| MI | $475.39–$510.29 | 2 |
| MN | $483.91 | 1 |
| MO | $454.24–$483.37 | 3 |
| MS | $446.08 | 1 |
| MT | $498.27 | 1 |
| NC | $465.29 | 1 |
| ND | $478.50 | 1 |
| NE | $453.44 | 1 |
| NH | $507.01 | 1 |
| NJ | $536.47–$560.29 | 2 |
| NM | $479.05 | 1 |
| NV | $493.08 | 1 |
| NY | $472.76–$595.88 | 5 |
| OH | $471.35 | 1 |
| OK | $457.37 | 1 |
| OR | $487.17–$526.99 | 2 |
| PA | $470.81–$520.36 | 2 |
| PR | $501.29 | 1 |
| RI | $507.95 | 1 |
| SC | $469.52 | 1 |
| SD | $476.16 | 1 |
| TN | $454.37 | 1 |
| TX | $467.77–$513.01 | 8 |
| UT | $476.14 | 1 |
| VA | $483.20–$566.07 | 2 |
| VI | $501.29 | 1 |
| VT | $478.71 | 1 |
| WA | $508.93–$570.93 | 2 |
| WI | $462.07 | 1 |
| WV | $471.69 | 1 |
| WY | $489.66 | 1 |
How the 23665 rate is calculated
Each of 23665’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 · 23665
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.54Practice expense 9.38Malpractice 1.00
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 23665
23665 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 23665
Shoulder reduction
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 23665
Shoulder reduction
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
23665 without 50 · national office
$498.34
Shoulder reduction
23665-50 · Bilateral: 150%
$747.51
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).
23665 compared with similar codes
Compare codes
23665 vs 23650 vs 23655 vs 23675 vs 23670: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 23650Shoulder reduction
- 23650 is for a shoulder dislocation treated by closed manipulation without the greater tuberosity fracture described by 23665.
- 23655Shoulder reduction
- 23655 addresses closed manipulation of a shoulder dislocation without an associated greater tuberosity fracture and specifies anesthesia.
- 23675Shoulder reduction
- Choose 23675 when the associated fracture is at the humeral surgical neck; 23665 is for a greater tuberosity fracture.
- 23670Shoulder surgery
- 23670 is the open-treatment option for a shoulder dislocation with fracture; 23665 describes closed treatment with manipulation.
23665 billing questions
Does this code include treatment of the greater tuberosity fracture?
Yes. The code includes closed treatment of the fracture along with closed manipulation of the shoulder dislocation; do not separately report another closed-treatment service for that fracture.
How does this differ from 23650 or 23655?
Those codes describe closed manipulation of a shoulder dislocation without the associated greater tuberosity fracture. Use 23665 when the dislocation and greater tuberosity fracture are both part of the injury being treated.
When is 23675 the better choice?
Use 23675 for a shoulder dislocation associated with a fracture of the humeral surgical neck. This code is for an associated greater tuberosity fracture.
Can the fracture treatment be billed separately?
The closed treatment of the greater tuberosity fracture is included in this service. Documentation should establish the dislocation, fracture location, and manipulation performed.
What does the 90-day global period include?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
How are bilateral cases and surgical assistance handled?
CMS pays bilateral procedures reported with modifier 50 at 150%. Assistant-at-surgery payment is statutorily restricted, and co-surgeons and team surgery are not permitted.
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
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