23616 Optx prx hmrl fracture fix repair rpl
Also known as: complex proximal humerus ORIF, ORIF with RC repair, proximal humerus ORIF with reconstruction
Open treatment of proximal humeral fracture with internal fixation and repair of rotator cuff and/or repair/replacement of articular surface. Complex proximal humerus ORIF with associated reconstructive procedures.
In Plain Language
surgery to fix upper arm fracture with additional repairs; complex shoulder fracture repair
Clinical Context
Used for proximal humeral fractures with rotator cuff tear, significant soft tissue injury, or articular surface damage requiring additional repair or replacement.
RVU Breakdown
| Work RVU | 17.91 |
| Total RVU | 17.91 |
Est. Medicare Payment
National estimate based on 2026 CMS PFS Conversion Factor ($33.40). Actual payment varies by locality (GPCI adjustment).
Billing & Documentation
As a surgical CPT code, proper documentation must include the operative report detailing the procedure performed, patient positioning, approach, findings, and any complications. This code has a 90-day global period, which includes the day of the procedure, 1 day preoperative, and 90 days of postoperative care. Ensure the diagnosis code (ICD-10) supports medical necessity for the procedure.
How This Code Compares
With a work RVU of 17.91, this code ranks in the 79th percentile among Surgery codes — 2.2x the median (8.00). The highest wRVU in this category is 106.19.
Specialties
Frequently Asked Questions
What is CPT code 23616?
CPT 23616 (Optx prx hmrl fracture fix repair rpl) is a Surgery code. Open treatment of proximal humeral fracture with internal fixation and repair of rotator cuff and/or repair/replacement of articular surface. Complex proximal humerus ORIF with associated reconstructive procedures.
What is the wRVU value for CPT 23616?
The work RVU for CPT 23616 is 17.91. This code is primarily used by Orthopedic Surgery, Trauma Surgery. It has a 90-day global period.
When is CPT 23616 used?
Used for proximal humeral fractures with rotator cuff tear, significant soft tissue injury, or articular surface damage requiring additional repair or replacement.
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CPT® is a registered trademark of the American Medical Association. Data sourced from CMS Physician Fee Schedule RVU26A. Descriptions, synonyms, and clinical context are original content by RVU Edge.