CPT 01630: Anesthesia for Shoulder and Adjacent Joint Surgery
Commercial payers pay $88 on average nationally for this procedure.
CPT code 01630 describes anesthesia services provided for open or arthroscopic surgical procedures on the humeral head and neck and the shoulder girdle joints (sternoclavicular, acromioclavicular, and shoulder joints); this represents anesthesia for shoulder and adjacent joint surgery, typically delivered in an operating room or ambulatory surgery center and encompassing general, regional, or monitored anesthesia care as appropriate for intraoperative management.
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
BUCA’s average commercial rate for CPT 01630 sits near $88, providing a convenient benchmark for comparison across payers. Blue Cross Blue Shield shows a relatively compressed middle spread with a P75–P25 range of $36.6 ($81.09 - $45.0), while UnitedHealth Group’s interquartile spread is $27.9 ($80.9 - $52.0), both indicating tighter clustering around the center. Cigna’s IQR is $58.6 ($125.0 - $68.4), and Aetna’s is $108.2 ($210.0 - $101.8), revealing progressively wider dispersion in commercial reimbursements.
Looking at extremes, Aetna also posts the highest individual maximum at $448.10, contributing to the greatest overall variability, whereas Blue Cross Blue Shield and UnitedHealth Group display the most constrained IQRs and therefore more predictable commercial rates. Cigna sits between the constrained and highly dispersed payers, and BUCA’s mean of $88 anchors the mid-market commercial level for CPT 01630.