Clavicular Fracture

Utilization Review Checklist

Derived from the ACOEM Shoulder Disorders Guideline, edition 14 July 2025, as adopted into the California MTUS 2 January 2026. CPT 23515, 23505. ICD-10 S42.0.

Draft — not reviewed or approved by COA. Prepared by Rette from the ACOEM guideline named above. This is not a COA document and does not reproduce COA’s own checklists.

Patient name: Claim #:

CriteriaCheck if documented

Confirmatory Diagnosis

Required

Clavicular fracture, with displacement, comminution and nonunion risk described
“Surgical intervention is moderately recommended for select patients with clavicular fractures.” — p. 589

Surgical Considerations (surgical treatment)

All of the following

Select patient, non-operative treatment being the alternative
“Surgical intervention is moderately recommended for select patients with clavicular fractures.” — p. 589
AND
Fixation technique planned
“Surgical intervention is moderately recommended for select patients with clavicular fractures.” — p. 589

Procedures — the guideline treats each separately

Surgical treatment for clavicular fractures

Moderately Recommended.

Strength of Evidence — Moderately Recommended, Evidence (B) · confidence high

Moderately Recommended on (B) evidence at HIGH confidence — a strong combination, and better evidenced than most fracture recommendations in these chapters. But it is for SELECT patients, and non-operative treatment is separately recommended, so the note has to say what makes this patient one of the select. The guideline identifies increasing age, female sex, comminution and displacement as risks for nonunion — those are the natural arguments.