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See a sample rate comparisonHealthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 11 - Office 23 - Emergency Room |
| Common Modifiers | None LT - Left side of body RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 23620 |
| Medicaid Fee Schedule | View Medicaid rates for 23620 |
National average reimbursement for CPT 23620 by major payers:

$375.39

$355.66

$372.46

$443.24
Choose a payer to see a sample of rates for CPT 23620.
University Of Kansas Hospital Authority
Mass General Brigham Incorporated
Tec North LLC
West Florida Medical Center Clinic, P.A.
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Rate Benchmarking
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonPayer Contract Negotiation
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See a sample payer proposalCPT 23620 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 23620 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 23620 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 |
|---|---|---|
| 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. |
| 23620-CPT | Moderate | Closed Treatment Of Greater Hu, Closed Treatment Of Greater Humeral Tuberosity Fracturewithout Manipulation Closed Treatment Of Greater Humeral Tuberosity Fracture |
| 23625-CPT | Moderate | Closed Treatment Of Greater Hu, Closed Treatment Of Greater Humeral Tuberosity Fracturewith Manipulation Closed Treatment Of Greater Humeral Tuberosity Fracture |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 23620. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 23620 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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