CPT code 23500 is for the closed treatment of a clavicular fracture without manipulation.
CPT code 23500 is used to describe the closed treatment of a clavicular fracture without manipulation. This means that the healthcare provider treats a broken collarbone without needing to physically adjust or realign the bone. This procedure typically involves immobilizing the area with a sling or other supportive device to allow the bone to heal naturally.
When billing for CPT code 23500 (Closed treatment of clavicular fracture; without manipulation), the following modifiers may be applicable depending on the specific circumstances of the treatment:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure is substantially greater than typically required.
2. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: Use this modifier if an evaluation and management service was performed during the postoperative period for a reason unrelated to the original procedure.
3. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: Use this modifier if a significant, separately identifiable evaluation and management service is provided by the same physician on the same day as the procedure.
4. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both sides of the body.
5. Modifier 51 - Multiple Procedures: Use this modifier if multiple procedures are performed during the same session.
6. Modifier 52 - Reduced Services: Use this modifier if the procedure is partially reduced or eliminated at the physician's discretion.
7. Modifier 54 - Surgical Care Only: Use this modifier if the physician is providing only the surgical care and not the preoperative or postoperative management.
8. Modifier 55 - Postoperative Management Only: Use this modifier if the physician is providing only the postoperative management.
9. Modifier 56 - Preoperative Management Only: Use this modifier if the physician is providing only the preoperative management.
10. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day.
11. Modifier 76 - Repeat Procedure or Service by Same Physician: Use this modifier if the procedure had to be repeated by the same physician.
12. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the procedure had to be repeated by a different physician.
13. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Use this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period.
14. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure or service is performed by the same physician during the postoperative period.
15. Modifier 80 - Assistant Surgeon: Use this modifier if an assistant surgeon is required for the procedure.
16. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is required for the procedure.
17. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon is required and a qualified resident surgeon is not available.
18. Modifier 99 - Multiple Modifiers: Use this modifier if multiple modifiers are necessary to describe the service provided.
These modifiers help provide additional information about the procedure and ensure accurate billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements or restrictions regarding the use of these modifiers.
CPT code 23500 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered under Medicare Part B, including CPT code 23500. However, the final determination of reimbursement is often managed by the Medicare Administrative Contractor (MAC) for your specific region. MACs are responsible for processing Medicare claims and can provide detailed information on coverage policies and reimbursement rates for CPT code 23500. It is advisable to consult the MPFS and your regional MAC to get precise information on the reimbursement for this code.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 23500. Schedule a demo today to see how RevFind can help you identify and recover revenue from individual payers.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
