CPT 00754 Reimbursement Benchmarks | OpenPayer

Summary & Overview

CPT 00754: Anesthesia for Shoulder and Axilla Procedures

CPT code 00754 represents anesthesia for procedures on the shoulder and axilla that are not otherwise specified, serving as a critical billing code for anesthesiology services in surgical settings. This code is widely used across outpatient hospitals, 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.

Readers will gain insight into the clinical context of 00754, including its application in shoulder and axilla surgeries, typical sites of service, and associated billing practices. The publication also highlights relevant modifiers, taxonomies, and related CPT codes, providing a comprehensive overview for healthcare professionals, billing specialists, and policy analysts. Key benchmarks and policy updates are discussed to inform stakeholders about current trends and requirements in anesthesiology billing. Understanding the scope and utilization of 00754 is essential for accurate reimbursement and compliance in surgical anesthesia services.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 00754anesthesiologyshoulder proceduresoutpatient hospitalmedical billinganesthesia codingclinical benchmarkspolicy updatespain medicinepediatric anesthesiology

CPT Code Overview

CPT code 00754 is used to report anesthesia services for procedures performed on the shoulder and axilla that are not otherwise specified. This code falls under the anesthesiology service type and is most commonly utilized in the outpatient hospital setting (Place of Service 22). It is designed to capture the complexity and requirements of providing anesthesia for a range of surgical interventions involving the shoulder and axillary region, ensuring appropriate billing and documentation for these specialized services.

Clinical & Coding Specifications

Clinical Context

A patient presents to the outpatient hospital with shoulder pain and limited mobility, potentially due to a rotator cuff tear, osteoarthritis, or a clavicle fracture. The orthopedic surgeon schedules a surgical procedure on the shoulder or axilla, such as arthroscopy or open repair. An anesthesiologist provides anesthesia services for the procedure, ensuring patient comfort and safety throughout. The anesthesia is tailored to the specific surgery and patient health status, and may involve monitored anesthesia care or general anesthesia. Documentation includes the anesthesia start and end times, patient status, and any modifiers relevant to the service.

Coding Specifications

Modifiers:
- QS: Monitored anesthesia care service. Used when the anesthesia provider delivers monitored anesthesia care rather than general anesthesia.
- P1: A normal healthy patient. Indicates the patient's physical status as normal and healthy.
Provider Taxonomies:

Taxonomy Code	Specialty Name
207L00000X

National Reimbursement Benchmarks

National mean rates for CPT code 00754 show that commercial payers such as Blue Cross Blue Shield and Cigna have significantly higher average reimbursement levels compared to UnitedHealth Group and BUCA. The mean rate for BUCA, representing the average commercial payer, is $174.92, while UnitedHealth Group is notably lower at $65.63. In contrast, Blue Cross Blue Shield and Cigna both exceed $399.00.

Rate dispersion varies widely across payers. UnitedHealth Group has the tightest range, with a difference of $25.47 between the 75th and 25th percentiles, indicating relatively consistent rates. Cigna displays the widest spread, with a $520.25 difference between the 75th and 25th percentiles, reflecting substantial variability in reimbursement. Blue Cross Blue Shield and Aetna also show considerable dispersion, with ranges of $249.25 and $376.00, respectively. The table and chart below present the full breakdown of national benchmarks for each payer.

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Alaska exhibits a substantial rate spread for CPT code 00754, particularly with Blue Cross Blue Shield, where the difference between the 75th and 25th percentiles is $254.17. In contrast, Aetna, Cigna, and UnitedHealth Group show minimal rate variation, with spreads of $0 to $4, indicating highly consistent reimbursement rates across providers for these payers. This suggests that Blue Cross Blue Shield's rates are more variable, while the other payers maintain flat fee schedules.

Compared to national averages, Blue Cross Blue Shield and Aetna in Alaska reimburse at significantly higher mean rates, while Cigna and UnitedHealth Group are below their national benchmarks. The table and chart below present the full breakdown of payer-specific rates in Alaska, highlighting these differences and the overall distribution of reimbursement levels.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer in Alaska for CPT 00754, with a mean rate of $485.49.
UnitedHealth Group offers the lowest mean rate at $75.12.
Mean rates for Aetna and Blue Cross Blue Shield in Alaska are notably higher than their respective national averages, while Cigna and UnitedHealth Group are below national benchmarks.

CPT 00756: Anesthesia for Procedures on the Upper Abdomen

00796-ANESTHESIA-FOR-INTRAPERITONEAL-PROCEDURES-IN-UPPER-ABDOMEN

CPT 00796: Anesthesia for Liver Transplant (Recipient)

00770-ANESTHESIA-FOR-PROCEDURES-ON-THE-MAJOR-ABDOMINAL-BLOOD

CPT 00770: Anesthesia for Major Abdominal Vascular Procedures

00750-ANESTHESIA-FOR-HERNIA-REPAIRS-IN-UPPER-ABDOMEN-NOT

CPT 00750: Anesthesia for Upper Abdominal Hernia Repair

00730-ANESTHESIA-FOR-PROCEDURES-ON-UPPER-POSTERIOR-ABDOMINAL

CPT 00730: Anesthesia for Upper Posterior Abdominal Wall Procedures

00790-ANESTHESIA-FOR-INTRAPERITONEAL-PROCEDURES-IN-UPPER-ABDOMEN

CPT 00790: Anesthesia for Upper Abdominal Intraperitoneal Procedures

CPT-00731-UPPER-GI-ENDOSCOPY-ANESTHESIA

CPT 00731: Anesthesia for Upper Gastrointestinal Endoscopy, Proximal Duodenum

CPT-00732-ERCP-ANESTHESIA-PROXIMAL-DUODENUM

CPT 00732: Anesthesia for ERCP to Proximal Duodenum

00752-ANESTHESIA-FOR-HERNIA-REPAIRS-IN-UPPER-ABDOMEN-LUMBAR-AND

CPT 00752: Anesthesia for Upper Abdominal Hernia Repairs

00792-ANESTHESIA-FOR-INTRAPERITONEAL-PROCEDURES-IN-UPPER-ABDOMEN

CPT 00792: Anesthesia for Partial Hepatectomy or Liver Hemorrhage Procedures

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Summary & Overview

CPT 00754: Anesthesia for Shoulder and Axilla 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