$286.53–$301.58
Use 23620 for closed treatment of a greater tuberosity fracture without manipulation; 23630 represents open surgical treatment.
On this page
CMS RVU26D · Effective 2026-10-01
23630 Humeral fracture repair Medicare reimbursement rates in Maine
Reports open surgical treatment of a fracture of the humeral greater tuberosity, with internal fixation when performed, rather than closed fracture care. Compare 23630 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 23630 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
No supported rate
Facility setting
$681.97–$705.27
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 surgery
About 23630: Open treatment of greater tuberosity fracture
Reports open surgical treatment of a fracture of the humeral greater tuberosity, with internal fixation when performed, rather than closed fracture care.
An orthopedic surgeon uses an open approach to treat a fracture of the greater tuberosity, the prominence on the upper humerus where rotator cuff tendons attach. Treatment may include exposing and reducing the fracture and securing it with fixation when needed. This code is for the fracture treatment itself; a shoulder dislocation associated with the fracture may point to a different code in the shoulder-dislocation family. Medicare use is concentrated in facility settings.
Select the code when the operative record supports open treatment of the greater tuberosity fracture. Document the fracture location, the open approach, and the treatment performed, including fixation details when applicable. The service has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 bilateral reporting is paid at 150%. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 23630
- 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 paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU10.31 · 47%
- Practice expense (office) RVU9.56 · 43%
- Malpractice RVU2.11 · 10%
1.9K
Medicare services in 2024 · #2484 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.
23630 compared with similar codes
Office rates for Maine, from the same CMS release.
$414.31–$434.83
Code 23625 is closed treatment with manipulation. Choose 23630 when the fracture is treated through an open approach.
$460.65–$483.20
Code 23665 describes closed treatment of a shoulder dislocation with a greater tuberosity fracture. This code is for open treatment of the fracture rather than that closed dislocation treatment.
No office rate
Code 23670 is for open treatment of a shoulder dislocation with a greater tuberosity fracture; 23630 addresses open treatment of the greater tuberosity fracture itself.
Compare 23630 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
Unavailable
Facility
$681.97
Southern Maine →
Office / nonfacility
Unavailable
Facility
$705.27
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23630 billing questions
When is this code preferable to closed treatment codes 23620 or 23625?
Use 23630 for open surgical treatment of the greater tuberosity fracture. Codes 23620 and 23625 describe closed treatment, with 23625 involving manipulation.
Does the code include internal fixation?
Yes. The code covers open treatment whether or not internal fixation is performed, so fixation is not separately reported as another fracture-treatment service.
What if the greater tuberosity fracture accompanies a shoulder dislocation?
Determine whether the documented procedure treats the fracture alone or treats a shoulder dislocation with the fracture. Codes 23665 and 23670 describe closed and open treatment, respectively, for the dislocation-with-fracture situation.
What documentation supports reporting 23630?
The operative report should identify the greater tuberosity fracture and establish that it was treated through an open approach. Include the reduction and fixation performed, if applicable.
How does the 90-day global period affect follow-up billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period. The code also follows the standard multiple-procedure reduction when other procedures are performed in the same session.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeons are paid only when supporting documentation is provided; 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.
2,23523616,,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
2,23923650,,Cltx sho dslc w/mnpj wo anes,A,,3.44,8.73,,6.75,,0.82,12.99,11.01,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,24023655,,Cltx sho dslc w/mnpj w/anes,A,,4.64,6.88,NA,6.88,,1.02,12.54,12.54,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,24123660,,Optx acute shoulder dislc,A,,7.47,7.55,NA,7.55,,1.48,16.50,16.50,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00