No office rate
Both describe open treatment of a proximal humerus fracture. Choose 23616 when prosthetic replacement is part of the treatment; 23615 does not include prosthetic replacement.
On this page
CMS RVU26D · Effective 2026-10-01
23616 in Beaumont
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$1076.85
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Orthopedic surgery
About 23616: Proximal humerus fracture replacement
Reports open operative treatment of a proximal humerus fracture when the treatment includes prosthetic replacement, with tuberosity repair or fixation included when performed.
An orthopedic surgeon uses this code for open treatment of a proximal humerus fracture that includes prosthetic replacement of the proximal humerus. This is typically a hospital or ambulatory surgical setting procedure for a fracture requiring replacement rather than fixation alone. The operative work may also include internal fixation or repair of the humeral tuberosities as part of treating the fracture.
The operative report should establish the proximal humerus fracture and document the open treatment and prosthetic replacement; describe fixation or tuberosity repair when performed. Those fracture-treatment elements are included in this code rather than separately reported as additional services. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 applies to a bilateral procedure, paid at 150%. Assistant-at-surgery and co-surgeon services may be paid; team surgery is not permitted.
CMS billing rules for 23616
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU17.91 · 53%
- Practice expense (office) RVU11.97 · 36%
- Malpractice RVU3.70 · 11%
460
Medicare services in 2024 · #3634 by national volume
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.
23616 compared with similar codes
Office rates for Beaumont, from the same CMS release.
$356.00
23600 describes closed treatment without manipulation. Use 23616 for open treatment that includes prosthetic replacement.
$502.13
23605 describes closed treatment with manipulation. It is not the open fracture-replacement service reported with 23616.
The same code, a different location
How does Beaumont compare?
23616 across payment areas
Same release and payment basis · bars start at $0
Beaumont · This locality
Unavailable
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Other payment areas listed in Texas appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Rest Of Texas
Texas · 23616
Office
Unavailable
Facility
$1089.22
No comparable office rate is available.
Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)
California · 23616
Office
Unavailable
Facility
$1177.77
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 23616
Office
Unavailable
Facility
$1239.04
No comparable office rate is available.
Miami
Florida · 23616
Office
Unavailable
Facility
$1326.95
No comparable office rate is available.
Chicago
Illinois · 23616
Office
Unavailable
Facility
$1287.83
No comparable office rate is available.
Manhattan
New York · 23616
Office
Unavailable
Facility
$1297.08
No comparable office rate is available.
Alaska*
Alaska · 23616
Office
Unavailable
Facility
$1391.21
No comparable office rate is available.
Alabama
Alabama · 23616
Office
Unavailable
Facility
$1017.99
No comparable office rate is available.
Arkansas
Arkansas · 23616
Office
Unavailable
Facility
$1005.29
No comparable office rate is available.
Arizona
Arizona · 23616
Office
Unavailable
Facility
$1091.41
No comparable office rate is available.
Bakersfield
California · 23616
Office
Unavailable
Facility
$1123.03
No comparable office rate is available.
Chico
California · 23616
Office
Unavailable
Facility
$1112.81
No comparable office rate is available.
El Centro
California · 23616
Office
Unavailable
Facility
$1113.43
No comparable office rate is available.
Fresno
California · 23616
Office
Unavailable
Facility
$1112.81
No comparable office rate is available.
Hanford-Corcoran
California · 23616
Office
Unavailable
Facility
$1112.81
No comparable office rate is available.
Madera
California · 23616
Office
Unavailable
Facility
$1112.81
No comparable office rate is available.
Merced
California · 23616
Office
Unavailable
Facility
$1112.81
No comparable office rate is available.
Modesto
California · 23616
Office
Unavailable
Facility
$1112.81
No comparable office rate is available.
Napa
California · 23616
Office
Unavailable
Facility
$1225.63
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 23616
Office
Unavailable
Facility
$1164.53
No comparable office rate is available.
Redding
California · 23616
Office
Unavailable
Facility
$1112.81
No comparable office rate is available.
Rest Of California
California · 23616
Office
Unavailable
Facility
$1112.81
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 23616
Office
Unavailable
Facility
$1152.58
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 23616
Office
Unavailable
Facility
$1150.96
No comparable office rate is available.
Salinas
California · 23616
Office
Unavailable
Facility
$1146.37
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 23616
Office
Unavailable
Facility
$1161.31
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 23616
Office
Unavailable
Facility
$1275.50
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 23616
Office
Unavailable
Facility
$1271.29
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 23616
Office
Unavailable
Facility
$1306.78
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 23616
Office
Unavailable
Facility
$1289.60
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 23616
Office
Unavailable
Facility
$1130.00
No comparable office rate is available.
Santa Cruz-Watsonville
California · 23616
Office
Unavailable
Facility
$1162.78
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 23616
Office
Unavailable
Facility
$1147.38
No comparable office rate is available.
Santa Rosa-Petaluma
California · 23616
Office
Unavailable
Facility
$1173.36
No comparable office rate is available.
Stockton
California · 23616
Office
Unavailable
Facility
$1112.81
No comparable office rate is available.
Vallejo
California · 23616
Office
Unavailable
Facility
$1219.57
No comparable office rate is available.
Visalia
California · 23616
Office
Unavailable
Facility
$1112.81
No comparable office rate is available.
Yuba City
California · 23616
Office
Unavailable
Facility
$1112.81
No comparable office rate is available.
Colorado
Colorado · 23616
Office
Unavailable
Facility
$1127.30
No comparable office rate is available.
Connecticut
Connecticut · 23616
Office
Unavailable
Facility
$1190.30
No comparable office rate is available.
Delaware
Delaware · 23616
Office
Unavailable
Facility
$1107.31
No comparable office rate is available.
Fort Lauderdale
Florida · 23616
Office
Unavailable
Facility
$1226.66
No comparable office rate is available.
Rest Of Florida
Florida · 23616
Office
Unavailable
Facility
$1166.17
No comparable office rate is available.
Atlanta
Georgia · 23616
Office
Unavailable
Facility
$1154.63
No comparable office rate is available.
Rest Of Georgia
Georgia · 23616
Office
Unavailable
Facility
$1102.15
No comparable office rate is available.
Hawaii, Guam
Hawaii · 23616
Office
Unavailable
Facility
$1124.35
No comparable office rate is available.
Iowa
Iowa · 23616
Office
Unavailable
Facility
$1013.10
No comparable office rate is available.
Idaho
Idaho · 23616
Office
Unavailable
Facility
$1024.49
No comparable office rate is available.
East St. Louis
Illinois · 23616
Office
Unavailable
Facility
$1214.93
No comparable office rate is available.
Rest Of Illinois
Illinois · 23616
Office
Unavailable
Facility
$1156.40
No comparable office rate is available.
Suburban Chicago
Illinois · 23616
Office
Unavailable
Facility
$1231.99
No comparable office rate is available.
Indiana
Indiana · 23616
Office
Unavailable
Facility
$1028.89
No comparable office rate is available.
Kansas
Kansas · 23616
Office
Unavailable
Facility
$1021.92
No comparable office rate is available.
Kentucky
Kentucky · 23616
Office
Unavailable
Facility
$1066.72
No comparable office rate is available.
New Orleans
Louisiana · 23616
Office
Unavailable
Facility
$1114.82
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 23616
Office
Unavailable
Facility
$1070.43
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 23616
Office
Unavailable
Facility
$1210.10
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 23616
Office
Unavailable
Facility
$1127.28
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 23616
Office
Unavailable
Facility
$1189.65
No comparable office rate is available.
Rest Of Maryland
Maryland · 23616
Office
Unavailable
Facility
$1122.25
No comparable office rate is available.
Rest Of Maine
Maine · 23616
Office
Unavailable
Facility
$1042.90
No comparable office rate is available.
Southern Maine
Maine · 23616
Office
Unavailable
Facility
$1072.40
No comparable office rate is available.
Detroit
Michigan · 23616
Office
Unavailable
Facility
$1192.39
No comparable office rate is available.
Rest Of Michigan
Michigan · 23616
Office
Unavailable
Facility
$1102.76
No comparable office rate is available.
Minnesota
Minnesota · 23616
Office
Unavailable
Facility
$1046.19
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 23616
Office
Unavailable
Facility
$1094.37
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 23616
Office
Unavailable
Facility
$1102.66
No comparable office rate is available.
Rest Of Missouri
Missouri · 23616
Office
Unavailable
Facility
$1063.22
No comparable office rate is available.
Mississippi
Mississippi · 23616
Office
Unavailable
Facility
$1033.77
No comparable office rate is available.
Montana**
Montana · 23616
Office
Unavailable
Facility
$1121.36
No comparable office rate is available.
North Carolina
North Carolina · 23616
Office
Unavailable
Facility
$1050.20
No comparable office rate is available.
North Dakota**
North Dakota · 23616
Office
Unavailable
Facility
$1048.19
No comparable office rate is available.
Nebraska
Nebraska · 23616
Office
Unavailable
Facility
$1013.95
No comparable office rate is available.
New Hampshire
New Hampshire · 23616
Office
Unavailable
Facility
$1122.55
No comparable office rate is available.
Northern Nj
New Jersey · 23616
Office
Unavailable
Facility
$1231.66
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 23616
Office
Unavailable
Facility
$1194.30
No comparable office rate is available.
New Mexico
New Mexico · 23616
Office
Unavailable
Facility
$1113.26
No comparable office rate is available.
Nevada**
Nevada · 23616
Office
Unavailable
Facility
$1101.36
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 23616
Office
Unavailable
Facility
$1341.36
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 23616
Office
Unavailable
Facility
$1212.46
No comparable office rate is available.
Queens
New York · 23616
Office
Unavailable
Facility
$1287.28
No comparable office rate is available.
Rest Of New York
New York · 23616
Office
Unavailable
Facility
$1064.91
No comparable office rate is available.
Ohio
Ohio · 23616
Office
Unavailable
Facility
$1087.81
No comparable office rate is available.
Oklahoma
Oklahoma · 23616
Office
Unavailable
Facility
$1051.26
No comparable office rate is available.
Portland
Oregon · 23616
Office
Unavailable
Facility
$1143.92
No comparable office rate is available.
Rest Of Oregon
Oregon · 23616
Office
Unavailable
Facility
$1083.30
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 23616
Office
Unavailable
Facility
$1172.61
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 23616
Office
Unavailable
Facility
$1082.02
No comparable office rate is available.
Puerto Rico
Puerto Rico · 23616
Office
Unavailable
Facility
$1124.15
No comparable office rate is available.
Rhode Island
Rhode Island · 23616
Office
Unavailable
Facility
$1132.81
No comparable office rate is available.
South Carolina
South Carolina · 23616
Office
Unavailable
Facility
$1072.68
No comparable office rate is available.
South Dakota**
South Dakota · 23616
Office
Unavailable
Facility
$1039.54
No comparable office rate is available.
Tennessee
Tennessee · 23616
Office
Unavailable
Facility
$1028.00
No comparable office rate is available.
Utah
Utah · 23616
Office
Unavailable
Facility
$1085.01
No comparable office rate is available.
Virginia
Virginia · 23616
Office
Unavailable
Facility
$1078.47
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 23616
Office
Unavailable
Facility
$1124.15
No comparable office rate is available.
Vermont
Vermont · 23616
Office
Unavailable
Facility
$1056.55
No comparable office rate is available.
Rest Of Washington
Washington · 23616
Office
Unavailable
Facility
$1121.03
No comparable office rate is available.
Seattle (King Cnty)
Washington · 23616
Office
Unavailable
Facility
$1219.65
No comparable office rate is available.
Wisconsin
Wisconsin · 23616
Office
Unavailable
Facility
$1019.29
No comparable office rate is available.
West Virginia
West Virginia · 23616
Office
Unavailable
Facility
$1122.49
No comparable office rate is available.
Wyoming**
Wyoming · 23616
Office
Unavailable
Facility
$1089.47
No comparable office rate is available.
See how rates vary across the country
23616 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Beaumont is a Medicare payment area. Our Census mapping connects it to 13 cities and communities in Texas, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 23616 in Beaumont. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$1184.53
$1076.85 × 110% = $1184.53
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 23616 in Beaumont.
PPRRVU2026_Oct_nonQPP.csv
2,235
- Code
- 23616
- Physician work
- 17.91
- Practice expense
- 11.97
- Malpractice
- 3.70
GPCI2026.csv
97
- Locality
- Beaumont
- Physician work
- 1.000
- Practice expense
- 0.910
- Malpractice
- 0.929
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 17.91 | × 1.000 | 17.9100 |
| Practice expense | 11.97 | × 0.910 | 10.8927 |
| Malpractice | 3.70 | × 0.929 | 3.4373 |
| Total RVUs | 32.2400 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Beaumont$1076.85
Open 23616 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 17.91 | 1 |
| Practice expense | 11.97 | 0.91 |
| Malpractice | 3.7 | 0.929 |
(17.91 × 1 + 11.97 × 0.91 + 3.7 × 0.929) × $33.4009 = $1076.85
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
23616 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
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
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $1076.85 | RVU26D |
| 2026-07-01 | Not available in this setting | $1076.85 | RVU26C |
| 2026-04-01 | Not available in this setting | $1076.85 | RVU26B |
| 2026-01-01 | Not available in this setting | $1076.85 | RVU26A |
| 2025-10-01 | Not available in this setting | $1157.87 | RVU25D |
| 2025-07-01 | Not available in this setting | $1157.87 | RVU25C |
| 2025-04-01 | Not available in this setting | $1157.87 | RVU25B |
| 2025-01-01 | Not available in this setting | $1157.87 | RVU25A |
23616 billing questions
How does this differ from 23615?
Use 23616 when open treatment of the proximal humerus fracture includes prosthetic replacement. Use 23615 for open treatment without prosthetic replacement.
Can tuberosity repair or internal fixation be billed separately?
No. When performed as part of treating the fracture, tuberosity repair and internal fixation are included in this code.
What documentation supports reporting 23616?
The operative report should identify the proximal humerus fracture, describe open treatment, and document prosthetic replacement. Include details of fixation or tuberosity repair when those steps were performed.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery services may be paid, and co-surgeons are permitted. Team surgery is 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
2,23223600,,Cltx prox humrl fx w/o mnpj,A,,2.93,7.87,,6.40,,0.61,11.41,9.94,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,23323605,,Cltx prx hmrl fx mnpj+-tract,A,,4.93,10.00,,7.19,,1.08,16.01,13.20,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,23423615,,Optx prox humrl fx w/int fix,A,,11.99,10.18,NA,10.18,,2.49,24.66,24.66,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,23523616,,Optx prx hmrl fx fix rpr rpl,A,,17.91,11.97,NA,11.97,,3.70,33.58,33.58,0,090,0.10,0.69,0.21,2,1,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,23623620,,Cltx gr hmrl tbrs fx wo mnpj,A,,2.49,6.28,,5.14,,0.50,9.27,8.13,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,23723625,,Cltx gr hmrl tbrs fx w/mnpj,A,,4.00,8.54,,6.42,,0.88,13.42,11.30,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,23823630,,Optx gr hmrl tbrs fx int fix,A,,10.31,9.56,NA,9.56,,2.11,21.98,21.98,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537
9604412,TX,31,AUSTIN,1.002,1.058,0.886
9704412,TX,20,BEAUMONT,1.000,0.910,0.929
9804412,TX,09,BRAZORIA,1.008,0.991,0.780
9904412,TX,11,DALLAS,1.009,0.996,0.858
10004412,TX,28,FORT WORTH,1.009,0.986,0.871