$352.37–$371.22
Both describe closed treatment of proximal humeral fractures; choose 23605 when manipulation is performed and 23600 when it is not.
On this page
CMS RVU26D · Effective 2026-10-01
23605 Fracture treatment Medicare reimbursement rates in Maine
Closed reduction of a proximal humeral fracture with manipulation, with or without traction, when the physician treats the fracture without open fixation. Compare 23605 office and facility rates across CMS payment localities in Maine.
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.
What does Medicare pay for 23605 in Maine?
Maine has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$494.39–$518.43
2 of 2 localities have a supported rate.
Facility setting
$408.04–$425.42
2 of 2 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Orthopedic fracture care
About 23605: Closed proximal humerus fracture reduction
Closed reduction of a proximal humeral fracture with manipulation, with or without traction, when the physician treats the fracture without open fixation.
CPT 23605 describes closed treatment of a fracture in the proximal humerus that requires manipulation to improve alignment. The physician performs a closed reduction rather than exposing the fracture for operative fixation; traction may be used as part of the treatment. Orthopedic surgeons commonly provide this care in a hospital, emergency setting, or office-based fracture service. A sling or other immobilization may follow reduction, depending on the fracture and treatment plan.
Report the code when documentation supports both a proximal humeral fracture and manipulation as part of its closed treatment. Record the fracture location, reduction performed, and relevant post-reduction findings. This code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For bilateral treatment, modifier 50 is paid at 150%. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Assistant-at-surgery services are not paid; co-surgeons and team surgery are not permitted.
CMS billing rules for 23605
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU4.93 · 31%
- Practice expense (office) RVU10.00 · 62%
- Malpractice RVU1.08 · 7%
1.2K
Medicare services in 2024 · #2859 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.
23605 compared with similar codes
Office rates for Maine, from the same CMS release.
No office rate
23605 is closed treatment with manipulation. 23615 is used for open treatment with internal fixation.
$414.31–$434.83
23625 is for closed manipulation treatment of a greater humeral tuberosity fracture; 23605 describes proximal humeral fracture treatment more broadly.
Compare 23605 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Rest Of Maine →
Office / nonfacility
$494.39
Facility
$408.04
Southern Maine →
Office / nonfacility
$518.43
Facility
$425.42
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23605 billing questions
When should I report 23605 instead of 23600?
Use 23605 when closed fracture treatment includes manipulation. Code 23600 describes closed treatment of a proximal humeral fracture without manipulation.
Does 23605 include the related postoperative visits?
Yes. Its 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How is bilateral treatment reported?
For bilateral proximal humeral fracture treatment, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant surgeon or co-surgeon be paid?
Assistant-at-surgery services are not paid under the stated statutory restriction. Co-surgeons and team surgery are not permitted.
What documentation supports 23605?
Document the proximal humeral fracture, that treatment was closed, and the manipulation performed. Include relevant post-reduction findings to support the treatment.
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.
2,23023575,,Cltx scap fx w/mnpj +-tractj,A,,4.12,8.74,,6.35,,0.88,13.74,11.35,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,23123585,,Optx scapular fx w/int fixj,A,,13.87,10.12,NA,10.12,,2.82,26.81,26.81,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,23223600,,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