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    OpenPayerBilling CodesAnesthesia for Procedures on the Thorax (Chest Wall and Shoulder Girdle)CPT cpt-00454-clavicle-biopsy-anesthesia
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    CPT 00454: Anesthesia for Clavicle Biopsy

    Commercial payers pay $80 on average nationally for this procedure.

    CPT code 00454 describes anesthesia services provided for a patient undergoing a biopsy of the clavicle (collarbone); this represents an anesthesia service for a diagnostic musculoskeletal biopsy typically performed in an operating room or procedure suite where monitored anesthesia care or general/regional anesthesia is delivered depending on clinical needs.

    For related coverage guidance, see recent payer policy updates: Dental Anesthesia Services, Anesthesia Services for Interventional Pain Management Procedures in an Adult, General Anesthesia and Conscious Sedation Services.

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    National Reimbursement Benchmarks

    National commercial rates for CPT 00454 center around BUCA’s average commercial benchmark of $80.10, with notable variation by payer. Blue Cross Blue Shield displays a relatively wide interquartile spread (P75–P25 = $45.30), while Cigna shows the next-widest dispersion at $61.00. UnitedHealth Group and Aetna are tighter by comparison, with interquartile ranges of $30.90 and $44.00 respectively, indicating more clustered pricing among those payers.

    Maximum-to-minimum spreads also underscore variability: Blue Cross Blue Shield reaches a maximum of $238.70 versus a minimum of $3.20, and Cigna’s maximum of $176.80 contrasts with a $52.00 minimum. UnitedHealth Group and Aetna remain more concentrated near their medians of $65 and $48, reinforcing that payer choice materially affects reimbursement levels for this code.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old patient with progressive shoulder pain and a small palpable lesion over the clavicle is scheduled for a diagnostic excisional biopsy of the clavicle under monitored anesthesia care. The surgical team includes an orthopedic surgeon performing a limited open biopsy of the clavicular cortex with local infiltration and possible bone curettage. The anesthesiology team evaluates the patient preoperatively, documents ASA physical status, reviews medications and allergies, and obtains informed consent for anesthesia. Typical intraoperative workflow includes placement of standard monitors, IV access, administration of sedation and analgesia (or general endotracheal anesthesia if indicated), continuous hemodynamic and respiratory monitoring, and readiness to convert to a deeper anesthetic if surgical complexity increases. Postoperative handoff to PACU includes pain control plan, neurovascular assessment of the operative limb, wound care instructions, and documentation of anesthetic agents, airway management, and any intraoperative events. Typical clinical setting is an outpatient ambulatory surgery center or hospital operating room depending on comorbidities and complexity.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    66984Extracapsular cataract removal with insertion of intraocular lensNot directly related anatomically; listed as a related anesthesia service code for ophthalmic procedures — included for anesthesia coding cross-reference only.

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207L00000X
    207LA0401X
    367500000X
    320700000X
    225C00000X
    2251G0304X
    2279P1004X
    207WX0109X

    Related Payer Policy Updates

    Specialty: Anesthesiology1 / 3

    10 rows

    PolicyPayerEffective Date
    Dental Anesthesia ServicesProvidence Health Plan2026-10-01
    Anesthesia Services for Interventional Pain Management Procedures in an AdultCigna2026-09-15
    General Anesthesia and Conscious Sedation ServicesUnitedHealthcare2026-09-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Elective Inpatient Services (for Idaho Only)UnitedHealthcare2026-06-01
    Sites of Servicepriority health2026-06-01
    Coverage for Ambulatory Surgery Unit (ASU)/Outpatient Facility and Anesthesia for Dental Servicesuniverahealthcare2026-05-21

    Related Codes

    CPT-00400-ANESTHESIA-INTEGUMENTARY-EXTREMITIES-ANTERIOR-TRUNK-PERINEUM

    CPT 00400: Anesthesia for Integumentary Procedures on Extremities/Trunk/Perineum

    CPT-00402-ANESTHESIA-INTEGUMENTARY-EXTREMITIES-TRUNK-PERINEUM-BREAST-RECONSTRUCT

    CPT 00402: Anesthesia for Integumentary Procedures on Extremities/Trunk/Perineum

    CPT-00404-ANESTHESIA-INTEGUMENTARY-EXTREMITIES-TRUNK-PERINEUM-BREAST

    CPT 00404: Anesthesia for Integumentary Procedures on Extremities/Trunk/Perineum

    CPT-00406-ANESTHESIA-INTEGUMENTARY-EXTREMITIES-ANTERIOR-TRUNK-PERINEUM

    CPT 00406: Anesthesia for Integumentary and Breast Procedures

    CPT-00410-ANESTHESIA-INTEGUMENTARY-PROCEDURES-ELECTRICAL-CARDIOVERSION

    CPT 00410: Anesthesia for Integumentary Procedures with Cardiac Electrical Conversion

    CPT-00450-ANESTHESIA-CLAVICLE-SCAPULA-PROCEDURE

    CPT 00450: Anesthesia for Clavicle and Scapula Procedures

    CPT-00470-PARTIAL-RIB-REMOVAL-ANESTHESIA

    CPT 00470: Anesthesia for Partial Rib Removal

    CPT-00472-PARTIAL-RIB-RESECTION-THORACOPLASTY-ANESTHESIA

    CPT 00472: Anesthesia for Partial Rib Resection with Thoracoplasty

    CPT-00474-ANESTHESIA-PARTIAL-RIB-RESECTION-THORACIC

    CPT 00474: Anesthesia for Partial Rib Resection

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    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.

    66982Complex cataract surgery with insertion of intraocular lensSee 66984 — related as an ophthalmic anesthesia reference; not used for clavicle biopsy but included in the provided related codes.
    00142Anesthesia for procedures on eye musclesAn ophthalmic anesthesia code included in the related list; not applicable to clavicle biopsy but may be referenced when coding anesthesia specialty services.
    00144Anesthesia for corneal transplantAnother ophthalmic anesthesia code from the provided list; not used for clavicle biopsy but present in the supplied related CPT set.