$363.25
23600 is for closed treatment without manipulation. Choose 23615 when the proximal humerus fracture is treated through an open surgical approach.
On this page
CMS RVU26D · Effective 2026-10-01
23615 Fracture repair Medicare reimbursement rates in Utah
Reports open surgical treatment of a proximal humerus fracture, with internal fixation when performed, rather than closed reduction and immobilization. Compare 23615 office and facility rates across CMS payment localities in Utah.
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 23615 in Utah?
Utah has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$794.78
1 of 1 localities have a supported rate.
Payment area: Utah
One mapped payment locality.
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 23615: Open proximal humerus fracture repair
Reports open surgical treatment of a proximal humerus fracture, with internal fixation when performed, rather than closed reduction and immobilization.
This code covers open surgical treatment of a fracture near the shoulder end of the humerus, such as a humeral head or neck fracture. An orthopedic surgeon typically exposes the fracture, restores alignment, and stabilizes it; fixation may use a plate and screws or another method. The service is commonly performed in a hospital operating room for fractures requiring direct surgical treatment.
Select the code when the proximal humerus fracture is treated openly, not when it is managed by closed treatment. The operative report should identify the fracture site, describe the open approach and reduction, and document fixation when performed. Internal fixation is part of this service, not a separate report for the same fracture treatment. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. 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 23615
- 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 RVU11.99 · 49%
- Practice expense (office) RVU10.18 · 41%
- Malpractice RVU2.49 · 10%
8.4K
Medicare services in 2024 · #1568 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.
23615 compared with similar codes
Office rates for Utah, from the same CMS release.
$511.03
23605 describes closed treatment with manipulation. It does not represent open reduction and fixation of the proximal humerus fracture.
No office rate
23616 applies when tuberosity repair accompanies open treatment of the proximal humerus fracture. Use 23615 when that additional repair is not part of the documented service.
No office rate
23630 is directed to open treatment of a greater tuberosity fracture. Use 23615 for open treatment of a proximal humerus fracture outside that more specific fracture description.
Compare 23615 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.
1 of 1 payment localities
Utah →
Office / nonfacility
Unavailable
Facility
$794.78
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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 23615 in Utah.
PPRRVU2026_Oct_nonQPP.csv
2,234
- Code
- 23615
- Physician work
- 11.99
- Practice expense
- 10.18
- Malpractice
- 2.49
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 11.99 | × 1.000 | 11.9900 |
| Practice expense | 10.18 | × 0.940 | 9.5692 |
| Malpractice | 2.49 | × 0.898 | 2.2360 |
| Total RVUs | 23.7952 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Utah$794.78
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 11.99 | 1 |
| Practice expense | 10.18 | 0.94 |
| Malpractice | 2.49 | 0.898 |
(11.99 × 1 + 10.18 × 0.94 + 2.49 × 0.898) × $33.4009 = $794.78
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.
23615 billing questions
How does this differ from 23600 or 23605?
Report 23615 for open surgical treatment of the proximal humerus fracture. Codes 23600 and 23605 describe closed treatment, with 23605 involving manipulation.
Is internal fixation separately reported?
No. Internal fixation, when performed as part of the open fracture treatment, is included in this service.
When should 23616 be considered instead?
Use 23616 when the open proximal humerus fracture treatment includes repair of one or more tuberosities. The operative documentation should support that additional repair.
What documentation supports reporting 23615?
Document the proximal humerus fracture site, the open surgical treatment and reduction, and the fixation method when fixation is performed.
How is bilateral reporting handled?
For bilateral procedures reported with modifier 50, CMS payment is 150%.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; 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.
2,23123585,,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
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
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985