Billing code 23616: Fracture repairMedicare rate & RVUs in Oregon
Reports open operative treatment of a proximal humerus fracture when the treatment includes prosthetic replacement, with tuberosity repair or fixation included when performed.
CMS doesn’t publish an office rate for 23616 in Oregon.
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 23616 covers
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.
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 23616 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $1,143.92 |
| Rest Of Oregon | Unavailable | $1,083.30 |
How the 23616 rate is calculated
Each of 23616’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 · 23616
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 17.91Practice expense 11.97Malpractice 3.70
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 23616
23616 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 23616
Fracture repair
| 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) | 2 | Paid. |
| Co-surgeons (62) | 2 | 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 · 23616
Fracture repair
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
23616 without 50 · national facility
$1,121.60
Fracture repair
23616-50 · Bilateral: 150%
$1,682.40
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).
23616 compared with similar codes
Compare codes
23616 vs 23615 vs 23600 vs 23605: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 23615Fracture repair
- 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.
- 23600Fracture care
- 23600 describes closed treatment without manipulation. Use 23616 for open treatment that includes prosthetic replacement.
- 23605Fracture treatment
- 23605 describes closed treatment with manipulation. It is not the open fracture-replacement service reported with 23616.
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 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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