CPT 23615 · Trauma / Fracture · Medicare (Palmetto GBA MAC)
ORIF Proximal Humerus Fracture (Surgical Neck) at Medicare (Palmetto GBA MAC).
How Medicare (Palmetto GBA MAC) approaches CPT 23615 (ORIF Proximal Humerus Fracture (Surgical Neck)) for prior-authorization review: at last review on 2026-05-02, the policy covers this code without prior authorization.
Free with practitioner sign-in — magic-link email auth, no credit card.
Criteria summary
High-level themes from the Medicare (Palmetto GBA MAC) policy of record for CPT 23615. Verbatim policy text and per-criterion analysis are available after sign-in.
- Imaging concordance documentation required.
Source: Medicare (Palmetto GBA MAC) LCD / Local Coverage Article
See the full Medicare (Palmetto GBA MAC) criteria.
Sign in for verbatim conservative-care language, exact imaging-concordance rules, repeat-procedure thresholds, and the denial-risk score for any specific clinical scenario.
Sign in — free for practitioners →