Summary & Overview
CPT 01202: Anesthesia for Shoulder and Axilla Procedures
CPT 01202 designates anesthesia for procedures on the shoulder and axilla when no more specific anesthesia code applies. As an anesthesiology code commonly used in outpatient hospital settings, it captures perioperative anesthesia services for shoulder surgeries and related procedures. Nationally, accurate use of CPT 01202 matters for appropriate clinical documentation, billing consistency, and alignment with payer policies governing operative anesthesia for upper-extremity procedures.
The analysis covers coverage by major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will find an overview of payer coverage expectations, clinical contexts in which the code is applied, and comparisons to closely related shoulder procedure codes. The content summarizes typical procedural scenarios that trigger use of this anesthesia code and highlights common associated procedure codes for clinical context.
This publication provides benchmarks for coding practice, clarifies the service setting commonly used with CPT 01202, and outlines relevant billing considerations for anesthesiology teams and billing professionals. Data not available in the input is noted where applicable.
CPT Code Overview
CPT 01202 describes anesthesia services provided for procedures on the shoulder and axilla when not otherwise specified. This code applies to anesthesiology services delivered in the context of surgical or procedural care. The typical site of service for CPT 01202 is Outpatient Hospital (POS 22), reflecting common use for same-day surgical procedures on the shoulder or axillary region.
Service Type: Anesthesiology
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to the outpatient hospital ambulatory surgery unit with shoulder pathology requiring a procedure in the shoulder or axilla under anesthesia. Common presenting complaints include persistent right shoulder pain, decreased range of motion, acute injury with suspected rotator cuff tear, or shoulder instability after trauma. Preoperative evaluation documents the diagnosis (for example, rotator cuff tear M75.100, acromioclavicular sprain S43.401A, or primary osteoarthritis M19.011), airway assessment, ASA physical status (frequently P1 for a healthy patient), and plan for monitored anesthesia care or general/regional anesthesia.
The clinical workflow: the patient arrives to the outpatient hospital (POS 22) preoperative area for routine assessment and consent. Anesthesia personnel (anesthesiologist or certified registered nurse anesthetist under supervising anesthesiologist) perform the pre-anesthesia evaluation and document the planned anesthetic technique. In the operating/procedure room, the anesthesia team provides monitored anesthesia care or a regional block or general anesthetic as indicated, documents intraoperative monitoring and medications, and records the start and end times of anesthesia services. Postoperative recovery occurs in the PACU with anesthesia handoff and discharge planning for outpatient care.
Coding Specifications
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Modifiers
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QS: Monitored anesthesia care service — used to indicate monitored anesthesia care rather than general anesthesia when documentation supports MA C for the procedure.