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    v1.0.30
    OpenPayerBilling CodesAnesthesia for Procedures on the Shoulder and AxillaCPT cpt-01610-shoulder-axilla-anesthesia-services
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    CPT 01610: Anesthesia for Shoulder and Axilla Procedures

    Commercial payers pay $92 on average nationally for this procedure.

    CPT code 01610 describes anesthesia services provided for procedures involving the nerves, muscles, tendons, fascia, and bursae of the shoulder and axilla; the service is regional anesthesia for shoulder/axilla procedures and is typically performed in an operating room or procedure suite associated with orthopedic or surgical care.

    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 pricing for CPT 01610 centers on a BUCA average commercial rate of $91.8, with individual payers showing notable variation around that benchmark. Blue Cross Blue Shield posts a relatively low dispersion between its 25th and 75th percentiles ($44.6 to $81.0), yielding a range of $36.4; UnitedHealth Group is similarly tight with a 25th–75th spread from $52.0 to $80.9, a range of $28.9. Cigna exhibits a wider middle spread ($68.4 to $125.0), range $56.6, while Aetna’s middle 50% spans $100.4 to $259.9, a very wide range of $159.5.

    Payer-specific medians and means cluster differently: Blue Cross Blue Shield and UnitedHealth Group sit below BUCA’s mean, whereas Cigna and Aetna are above it on average. Aetna’s large interquartile range signals the greatest price dispersion among these commercial payers, while UnitedHealth Group shows the tightest dispersion, followed by Blue Cross Blue Shield, suggesting more consistent contracted rates for those payers within their respective midranges.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old male with symptomatic right shoulder rotator cuff tendinopathy and bursitis is scheduled for arthroscopic subacromial decompression and rotator cuff repair under monitored general anesthesia with an interscalene nerve block. The patient has a history of controlled hypertension (ASA P2). Preoperative evaluation includes anesthesia assessment, airway exam, medication reconciliation, and informed consent. On the day of surgery the anesthesia team places standard monitors, performs an ultrasound-guided interscalene block for surgical analgesia, induces general anesthesia, manages intraoperative hemodynamics, documents regional block performance and duration, and provides postoperative handoff to PACU staff with pain plan. The procedure involves operative manipulation of the nerves, muscles, tendons, fascia, and bursae of the shoulder and axilla, matching the service described by 01610. Typical sites of service are an ambulatory surgery center or hospital operating room. Expected clinical workflow includes pre-op evaluation, regional block placement, intraoperative anesthesia management, emergence, and postoperative recovery with documentation for billing of the anesthesia service using 01610.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    29881Arthroscopy, shoulder or knee — arthroscopy, knee, surgical; with meniscectomy

    Related Modifiers

    9 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…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    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…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207L00000X
    367500000X
    207RA0401X
    1223G0001X
    261QX0100X
    213EG0000X
    2279P1004X
    246W00000X

    Related ICD-10-CM Codes

    27 rows

    ICD-10-CM CodeDescription
    G56.01Carpal tunnel syndrome, right upper limb
    G56.02Carpal tunnel syndrome, left upper limb
    M17.11Unilateral primary osteoarthritis, right knee
    M17.12Unilateral primary osteoarthritis, left knee
    M19.011Primary osteoarthritis, right shoulder
    M23.50Chronic instability of knee, unspecified knee
    M24.211Disorder of ligament, right shoulder
    M24.221Disorder of ligament, right elbow
    M25.511Pain in right shoulder
    M25.512Pain in left shoulder

    Showing 1–10 of 27

    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-01620-ANESTHESIA-CLOSED-PROCEDURE-SHOULDER-JOINT

    CPT 01620: Anesthesia for Closed Shoulder Joint Procedures

    CPT-01622-ANESTHESIA-DIAGNOSTIC-SHOULDER-ARTHROSCOPY

    CPT 01622: Anesthesia for Diagnostic Shoulder Arthroscopy

    CPT-01630-SHOULDER-ANESTHESIA-OPEN-ARTHROSCOPIC-PROCEDURES

    CPT 01630: Anesthesia for Shoulder and Adjacent Joint Surgery

    CPT-01634-SHOULDER-ANESTHESIA-OPEN-ARTHROSCOPIC-SHOULDER-PROCEDURES

    CPT 01634: Anesthesia for Open or Arthroscopic Shoulder Procedures

    CPT-01636-ANESTHESIA-SHOULDER-FOREQUARTER-AMPUTATION

    CPT 01636: Anesthesia for Shoulder and Forequarter Surgical Procedures

    CPT-01638-SHOULDER-JOINT-REPLACEMENT-ANESTHESIA

    CPT 01638: Anesthesia for Shoulder Joint Replacement

    CPT-01650-SHOULDER-AXILLA-ARTERY-ANESTHESIA

    CPT 01650: Anesthesia for Arteries of Shoulder and Axilla

    CPT-01652-ANESTHESIA-AXILLARY-BRACHIAL-ARTERY-ANEURYSM-SURGERY

    CPT 01652: Anesthesia for Axillary–Brachial Artery Aneurysm Surgery

    CPT-01654-SHOULDER-AXILLA-ARTERY-BYPASS-ANESTHESIA

    CPT 01654: Anesthesia for Bypass Graft of Shoulder/Axilla Arteries

    CPT-01656-AXILLARY-TO-FEMORAL-BYPASS-ANESTHESIA

    CPT 01656: Anesthesia for Axillary-to-Femoral Bypass Graft

    Showing 1–10 of 12

    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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    May be performed in the same setting for knee procedures; anesthesia 01610 covers regional anesthesia for shoulder/axilla but is conceptually similar for operative joint procedures.
    29880Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral)Related arthroscopic joint procedures that often require intraoperative anesthesia management similar to shoulder procedures.
    27447Total knee arthroplastyMajor joint replacement procedure requiring comprehensive anesthesia care; included as a related major orthopedic procedure in perioperative planning.
    20610Arthrocentesis, aspiration and/or injection into a joint or bursaDiagnostic or therapeutic injections performed pre- or postoperatively; anesthesia services may be billed separately if significant anesthesia is provided.