CPT 00450: Anesthesia for Clavicle and Scapula Procedures
CPT code 00450 designates anesthesia services for surgical or procedural care of the clavicle and scapula when no more specific anesthesia code applies. This code captures perioperative anesthesia time and complexity tied to upper-torso osseous procedures and is used by anesthesiology clinicians when billing for care during clavicle or scapula interventions. Nationally, accurate use of this code supports payment alignment for anesthesia teams and ensures appropriate classification of resource use for shoulder girdle procedures.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for anesthetic management of clavicle and scapula procedures, common related diagnoses that prompt use of the code, and relevant sibling anesthesia codes used for comparison. The publication outlines typical sites of service and service type to aid coding accuracy and billing consistency across payers.
This summary also highlights where 00450 fits within anesthesia coding for upper-torso bone procedures and points to adjacent CPT anesthesia codes used for similar anatomical regions. The content is intended to inform coding, billing, and administrative staff about the function and clinical scope of the code in a national payer mix.
Sign up for cpt 00450 policy alerts
Get alerted when payer policies referencing 00450 are released or updated.
Billing Code Overview
CPT code 00450 describes anesthesia services provided for procedures on the clavicle and scapula when no more specific anesthesia code applies. The service type is anesthesia for clavicle and scapula procedures, and the typical site of service is an operating room or procedure suite where surgical interventions on the clavicle and scapula are performed.
Clinical & Coding Specifications
Clinical Context
A 48-year-old male presents to the orthopedic clinic after a fall onto his right shoulder. Imaging confirms a displaced fracture of the midshaft right clavicle (S42.001A) with significant pain (M25.511) and limited range of motion. The orthopedic surgeon schedules open reduction and internal fixation of the right clavicle. An anesthesia team (an anesthesiologist or CRNA with anesthesiology supervision) provides general endotracheal anesthesia with regional interscalene block for perioperative analgesia. Preoperative evaluation documents comorbid primary osteoarthritis of the right shoulder (M19.011) and a chronic rotator cuff tear (M75.100), which inform airway and analgesic planning.
The clinical workflow includes pre-anesthesia assessment in the preop holding area, informed consent for anesthesia, intraoperative monitoring and maintenance of anesthesia in the operating room during clavicle fixation, multimodal analgesia including a peripheral nerve block performed by the anesthesiology team, postoperative handoff to PACU staff for pain control and monitoring, and documentation of anesthesia start/stop times and any intraoperative complications. Typical site of service is an ambulatory surgery center or hospital operating room. The service type is anesthesia for procedures on the clavicle and scapula as represented by 00450.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when anesthesia services required substantially greater work due to complexity, documented and supported by anesthesia record and operative findings. |
23 | Unusual anesthesia | Use when general anesthesia is medically necessary for a procedure that is normally performed without it, documented with rationale. |
50 | Bilateral procedure | Use if identical procedures are performed on both clavicles or scapulae during same session. |
52 | Reduced services | Use when the anesthesia service is partially reduced or not fully performed as planned. |
53 | Discontinued procedure | Use when anesthesia is provided but the surgical procedure is terminated prior to completion for clinical reasons. |
62 | Two surgeons | Use when two surgeons are required concurrently and anesthesia documentation supports shared operative complexity affecting anesthetic management. |
78 | Unplanned return to OR | Use when the patient returns to the operating room for a related procedure during the postoperative global period and additional anesthesia is required. |
AA | Anesthesia by anesthesiologist | Use to identify anesthesia personally performed by a physician anesthesiologist. |
AD | Medical supervision by physician; more than four concurrent anesthesia procedures | Use when a physician supervises multiple concurrent CRNAs/AA providers as documented. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Use when an advanced practice provider assists and reporting requires this modifier in payer-specific situations. |
QK | Medical direction of two, three, or four concurrent anesthesia providers (CRNA/AA) | Use when the anesthesiologist medically directs multiple simultaneous CRNAs/AAs and documentation meets CMS criteria. |
QS | Monitored anesthesia care (MAC) service | Use when MAC is provided instead of general or regional anesthesia and should be appended where payer requires distinction. |
QX | CRNA service furnished under supervision of anesthesiologist | Use to identify CRNA services billed under supervision arrangements. |
QY | Anesthesiologist medically directing one CRNA/AA | Use when the anesthesiologist directs a single CRNA/AA and documentation supports direction. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Anesthesiology | Physicians specializing in perioperative anesthesia and regional blockade; typically bill 00450 when providing services for clavicle/scapula procedures. |
367500000X | Certified Registered Nurse Anesthetist | CRNAs commonly provide anesthesia for orthopedic clavicle procedures, often billed with supervision modifiers such as QX or QK per payer rules. |
207RA0401X | Anesthesiology Assistant | Anesthesiology Assistants participate under physician supervision; use of modifiers for medical direction or supervision depends on payer policies. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M75.100 | Unspecified rotator cuff tear or rupture of shoulder | Rotator cuff pathology may coexist with clavicle/scapula injuries and influence intraoperative positioning and analgesic plan. |
S43.401A | Sprain of unspecified acromioclavicular joint, initial encounter | AC joint sprains commonly accompany clavicle injuries or shoulder trauma requiring anesthesia for diagnostic or surgical intervention. |
M19.011 | Primary osteoarthritis, right shoulder | Degenerative shoulder disease may be present in older patients undergoing clavicle or scapula surgery and affects perioperative pain management. |
S42.001A | Fracture of unspecified part of right clavicle, initial encounter | Direct surgical indication for 00450; primary diagnosis driving anesthesia for clavicle fixation. |
M25.511 | Pain in right shoulder | Symptom diagnosis that often accompanies clavicle/scapula pathology and is documented in preoperative evaluation. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
00400 | Anesthesia for procedures on integumentary system on the extremities, anterior trunk and perineum | Alternative anesthesia code used for certain anterior trunk procedures; may be considered when procedure involves soft tissue of the anterior shoulder region rather than bone. |
00454 | Anesthesia for procedures on clavicle and scapula (biopsy procedure) | Related code for anesthesia when the surgical procedure is a biopsy of the clavicle or scapula; distinguishes procedure type within same anatomic region. |
00470 | Anesthesia for partial rib resection | Nearby thoracic/anterior chest anesthesia code; included for clinical grouping and coder cross-check when procedures involve adjacent ribs or chest wall in addition to clavicle/scapula. |