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See a sample rate comparisonCPT 23616 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Optx Prx Hmrl Fx Fix Rpr Rpl, Open Treatment Of Proximal Humeral Surgical Or Anatomical Neck Fracture Includes Internal Fixation When Performed Includes Repair Of Tuberosity S When Performed With Proximal Humeral Prosthetic Replacement
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 23616 |
| Medicaid Fee Schedule | View Medicaid rates for 23616 |
National average reimbursement for CPT 23616 by major payers:
$1,741.72
$1,721.87
$1,749.94
$2,059.56
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CPT 23616
5 of 25 sample ratesHigher to lower in this preview
North State Surgery Centers Lp, Court Street Surgery Center
$11,106.00Published rateAzendo LLC, Tri-Pointe Surgery Center
Azendo LLC
$5,963.00Published rateHauppauge Sc, LLC
Hauppauge Sc LLC
$4,656.00Published rateBernstein Hilliker Hartzell Eye Center LLP, The Surgery Center Of Central PA
The Eye Center Of Central PA, LLP
$3,350.00Published rateAdvanced Laser & Surgicenter Of Arizona, PC
$822.00Published rate
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See a sample payer proposalCPT 23616 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 23616 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 23616 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 23600-CPT | Moderate | Closed Treatment Of Proximal H, Closed Treatment Of Proximal Humeral (Surgical Or Anatomicalneck) Fracture Without Manipulation Closed Treatment Of Proximal Humeral (Surgical Or Anatomical |
| 23605-CPT | Moderate | Cltx Prx Hmrl Fx Mnpj Tract, Closed Treatment Of Proximal Humeral Surgical Or Anatomical Neck Fracture With Manipulation With Or Without Skeletal Traction |
| 23615-CPT | High | Surgical Repair Of Broken Arm, Surgery To Repair A Broken Upper Arm Bone (Humerus). The Procedure Can Involve The Use Of Wires Pins Plates Rings Or Screws To Hold The Bone Together. Repair May Include A Prosthesis Or Implant. |
| 23616-CPT | High | Optx Prx Hmrl Fx Fix Rpr Rpl, Open Treatment Of Proximal Humeral Surgical Or Anatomical Neck Fracture Includes Internal Fixation When Performed Includes Repair Of Tuberosity S When Performed With Proximal Humeral Prosthetic Replacement |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 23616. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 23616 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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