CPT 00450 Reimbursement Benchmarks & Policy | OpenPayer

Summary & Overview

CPT 00450: Anesthesia for Clavicle and Scapula Procedures

CPT code 00450 covers anesthesia for procedures performed on the clavicle and scapula, a critical area in orthopedic and trauma surgery. This code is widely used by anesthesiology professionals in outpatient hospital settings, reflecting its importance in both routine and complex shoulder surgeries. Nationally, the code is recognized by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, ensuring broad coverage for patients undergoing these procedures.

The publication provides a comprehensive overview of 00450, including payer coverage, clinical context, and relevant billing modifiers. Readers will gain insight into typical use cases, associated diagnoses, and related CPT codes, offering a clear understanding of how this code fits into the broader landscape of anesthesia billing. Policy updates and benchmarks are also discussed, equipping healthcare professionals and administrators with the information needed to navigate reimbursement and compliance for anesthesia services on the clavicle and scapula. The analysis highlights the significance of accurate coding and documentation, supporting efficient claims processing and quality patient care.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00450anesthesiologyoutpatient hospitalshoulder surgeryclavicle proceduresscapula proceduresmedical billinganesthesia codingclinical documentationpolicy updates

CPT Code Overview

CPT code 00450 is designated for anesthesia services provided during procedures involving the clavicle and scapula. This code falls under the anesthesiology service type and is most commonly utilized in the outpatient hospital setting, specifically at Place of Service 22. The code is essential for accurately capturing anesthesia care for a range of surgical interventions on the shoulder girdle, ensuring proper documentation and billing for these specialized procedures.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult presenting to the outpatient hospital with acute pain and limited mobility in the right shoulder following a fall. Imaging reveals a fracture of the right clavicle (S42.001A) and possible rotator cuff tear (M75.100). The patient is scheduled for surgical repair of the clavicle, requiring anesthesia services for the procedure. An anesthesiologist or a certified registered nurse anesthetist (CRNA) provides anesthesia care, ensuring patient comfort and safety throughout the operation. The clinical workflow includes preoperative assessment, administration of anesthesia, intraoperative monitoring, and postoperative recovery in the outpatient setting.

Coding Specifications

Modifiers:
- QS: Monitored anesthesia care service. Used when the anesthesia provider delivers monitored anesthesia care (MAC) during the procedure.
- QX: CRNA service with medical direction by a physician. Used when a CRNA provides anesthesia under the medical direction of an anesthesiologist.
Provider Taxonomies:

Taxonomy Code Specialty Name

National Reimbursement Benchmarks

National mean rates for CPT code 00450 show that commercial payers (BUCA) average $168.91, while Medicare rates are not available in the input. Among individual commercial payers, Cigna has the highest mean rate at $298.29, followed by Blue Cross Blue Shield at $279.10 and Aetna at $249.04. UnitedHealth Group is notably lower at $65.63.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly. Cigna exhibits the widest spread ($433.00 - $88.00 = $345.00), indicating substantial variability in reimbursement. UnitedHealth Group has the tightest range ($75.80 - $50.33 = $25.47), suggesting more consistent rates. Blue Cross Blue Shield and Aetna also show considerable dispersion, while BUCA's range is moderate.

The table and chart below present a detailed breakdown of national benchmarks for each payer.

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Alaska exhibits a wide spread in reimbursement rates for CPT code 00450, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($96.90), while Aetna, Cigna, and UnitedHealth Group display minimal spreads ($0–$8). This indicates that Blue Cross Blue Shield's rates are more variable, whereas other payers maintain consistent rates across providers. Compared to national averages, Blue Cross Blue Shield and BUCA payers in Alaska offer higher mean rates, while Cigna and UnitedHealth Group are notably below their national benchmarks.

The table and chart below present the full breakdown of mean rates and percentile distributions for each payer in Alaska, highlighting the differences in reimbursement levels and variability across the market.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 00450 in Alaska, with a mean rate of $329.81.
UnitedHealth Group offers the lowest mean rate in Alaska at $75.12.
Cigna's mean rate in Alaska ($89.33) is significantly below its national average ($298.29), while Blue Cross Blue Shield's mean rate in Alaska is notably above its national average ($279.10).

CPT 00402: Anesthesia for Neck, Esophagus, and Airway Procedures

00406-ANESTH-SURGERY-OF

CPT 00406: Anesthesia for Breast Surgery

00404-ANESTHESIA-FOR-PROCEDURES-ON-THE-INTEGUMENTARY-SYSTEM-ON

CPT 00404: Anesthesia for Radical Breast and Integumentary Procedures

00470-ANESTHESIA-FOR-PARTIAL-RIB

CPT 00470: Anesthesia for Partial Rib Resection

00454-ANESTHESIA-FOR-PROCEDURES-ON-CLAVICLE-AND

CPT 00454: Anesthesia for Clavicle and Scapula Procedures

00474-ANESTHESIA-FOR-PROCEDURES-ON-THE-THORAX-CHEST-WALL-AND

CPT 00474: Anesthesia for Thoracic Procedures, Chest Wall and Shoulder Girdle

00400-ANESTHESIA-FOR-PROCEDURES-ON-THE-INTEGUMENTARY-SYSTEM-ON

CPT 00400: Anesthesia for Skin and Soft Tissue Procedures on Extremities and Trunk

00410-ANESTHESIA-FOR-PROCEDURE-TO-CORRECT-ABNORMAL-HEART

CPT 00410: Anesthesia for Procedure to Correct Abnormal Heart Rhythm

00472-ANESTHESIA-FOR-PARTIAL-RIB

CPT 00472: Anesthesia for Partial Rib Resection

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

`207L00000X`	Anesthesiology
`367500000X`	Certified Registered Nurse Anesthetist (CRNA)
`207RA0401X`	Anesthesiology Assistant

OpenPayer

Summary & Overview

CPT 00450: Anesthesia for Clavicle and Scapula Procedures

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes

Related Diagnoses

Related CPT Codes

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes