Billing code 23650: Shoulder reductionMedicare rate & RVUs in Nevada
Reports closed manipulation to reduce a shoulder dislocation when the reduction is performed without anesthesia, such as in an emergency department or office.
Medicare pays $429.60 for 23650 in the office in Nevada (Nevada**). Which amount applies depends on the service address.
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 9 sections
What 23650 covers
This service covers closed manipulation to restore alignment after a shoulder dislocation, without anesthesia. A common situation is an emergency physician or orthopedic surgeon reducing an uncomplicated glenohumeral dislocation in an emergency department; the service may also occur in an office or other appropriate setting. The code is for a dislocation treated by manipulation, not a proximal humeral fracture treated as a fracture or an open reduction.
Report the code when the shoulder is reduced by manipulation and anesthesia is not used for the procedure; the anesthesia distinction separates it from 23655. Document the dislocation, side, manipulation and reduction performed, and anesthesia status. 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 one session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery services are not paid; 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.
23650 in Nevada**
| Payment locality | Office | Facility |
|---|---|---|
| Nevada** | $429.60 | $363.40 |
How the 23650 rate is calculated
Each of 23650’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 · 23650
RVUs × geographic indexes × conversion factor
Work3.44
3.44 RVUs× 1.000 GPCI
Practice expense8.73
8.73 RVUs× 1.000 GPCI
Malpractice0.82
0.82 RVUs× 1.000 GPCI
Adjusted RVUs
12.9900
Conversion factor
$33.4009
Medicare rate
$433.88
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 23650
23650 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 23650
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 · 23650
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
23650 without 50 · national office
$433.88
Shoulder reduction
23650-50 · Bilateral: 150%
$650.82
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).
23650 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 23655Shoulder reduction
- Both are closed manipulations for shoulder dislocation; 23650 is for reduction without anesthesia, while 23655 is for reduction with anesthesia.
- 23665Shoulder reduction
- Use 23665 for a shoulder dislocation accompanied by a greater tuberosity fracture treated closed, rather than an isolated dislocation.
- 23660Shoulder dislocation
- 23660 describes open treatment of an acute shoulder dislocation; 23650 describes closed manipulation without anesthesia.
- 23600Fracture care
- 23600 is closed treatment of a proximal humeral fracture without manipulation, not closed reduction of a shoulder dislocation.
23650 billing questions
How does 23650 differ from 23655?
Both describe closed manipulation of a shoulder dislocation. Use 23650 when the reduction is performed without anesthesia and 23655 when anesthesia is used.
Does a dislocation with a humeral fracture belong under this code?
A dislocation accompanied by a specified humeral fracture may fall under a separate fracture-dislocation code, such as 23665 for a greater tuberosity fracture. Choose based on the documented injury and treatment, not the dislocation alone.
What should the record show?
Document the affected side, the shoulder dislocation, the manipulation and reduction performed, and whether anesthesia was used. These details support the code and distinguish it from fracture-dislocation treatment.
How is bilateral treatment reported?
When both shoulders are treated, report bilateral services with modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant or another surgeon be reported?
CMS does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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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