No office rate
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.
On this page
CMS RVU26D · Effective 2026-10-01
23616 Fracture repair Medicare reimbursement rates in Wisconsin
Reports open operative treatment of a proximal humerus fracture when the treatment includes prosthetic replacement, with tuberosity repair or fixation included when performed. Compare 23616 office and facility rates across CMS payment localities in Wisconsin.
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 23616 in Wisconsin?
Wisconsin 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
$1019.29
1 of 1 localities have a supported rate.
Payment area: Wisconsin
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 23616: Proximal humerus fracture replacement
Reports open operative treatment of a proximal humerus fracture when the treatment includes prosthetic replacement, with tuberosity repair or fixation included when performed.
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.
CMS billing rules for 23616
- 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 permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU17.91 · 53%
- Practice expense (office) RVU11.97 · 36%
- Malpractice RVU3.70 · 11%
460
Medicare services in 2024 · #3634 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.
23616 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
$355.96
23600 describes closed treatment without manipulation. Use 23616 for open treatment that includes prosthetic replacement.
$495.76
23605 describes closed treatment with manipulation. It is not the open fracture-replacement service reported with 23616.
Compare 23616 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
Wisconsin →
Office / nonfacility
Unavailable
Facility
$1019.29
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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 23616 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
2,235
- Code
- 23616
- Physician work
- 17.91
- Practice expense
- 11.97
- Malpractice
- 3.70
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 17.91 | × 1.000 | 17.9100 |
| Practice expense | 11.97 | × 0.958 | 11.4673 |
| Malpractice | 3.70 | × 0.308 | 1.1396 |
| Total RVUs | 30.5169 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wisconsin$1019.29
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 17.91 | 1 |
| Practice expense | 11.97 | 0.958 |
| Malpractice | 3.7 | 0.308 |
(17.91 × 1 + 11.97 × 0.958 + 3.7 × 0.308) × $33.4009 = $1019.29
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.
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 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.
2,23223600,,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
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
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,