CPT 23616 · Trauma — Upper Extremity · Railroad Medicare (Palmetto GBA national)
ORIF Proximal Humerus with Prosthetic Replacement at Railroad Medicare (Palmetto GBA national).
How Railroad Medicare (Palmetto GBA national) approaches CPT 23616 (ORIF Proximal Humerus with Prosthetic Replacement) for prior-authorization review: at last review on 2026-05-09, the policy covers this code without prior authorization.
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Criteria summary
High-level themes from the Railroad Medicare (Palmetto GBA national) policy of record for CPT 23616. Verbatim policy text and per-criterion analysis are available after sign-in.
Coverage criteria details available after sign-in.
Source: Railroad Medicare (Palmetto GBA) follows CMS NCDs
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