CPT 01630: Anesthesia for Open or Arthroscopic Shoulder Procedures

CPT code 01630 represents anesthesia services delivered for open or arthroscopic procedures targeting the humeral head and neck, sternoclavicular, acromioclavicular, and shoulder joints. This code captures anesthesia care specific to shoulder and adjacent-joint surgical interventions and is used across hospital operating rooms and ambulatory surgery centers. Nationally, accurate use of this code supports appropriate payment for perioperative anesthetic management tied to shoulder surgeries and assists payers and providers in categorizing anesthesia resource use.

Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find coverage and billing context relevant to those payers, typical sites of service, and clinical scenarios that generate use of the code. The report highlights how 01630 is applied in relation to diagnostic and surgical shoulder procedures, presents benchmarks and common billing practices, and summarizes associated service lines and related anesthesia codes for shoulder and axillary procedures.

The content provides a concise clinical context for coders, billing managers, and policy analysts seeking to understand when to assign CPT code 01630, how it relates to shoulder surgical care, and what national payers generally consider when processing claims for anesthesia services in these procedures.

Billing Code Overview

CPT code 01630 describes anesthesia services provided for open or arthroscopic procedures involving the humeral head and neck, sternoclavicular, acromioclavicular, and shoulder joints. The service type is anesthesia for shoulder and adjacent joint surgical procedures. Typical sites of service include operating room or ambulatory surgical center settings where open or arthroscopic shoulder procedures are performed.

Clinical Context

A 58-year-old male presents with progressive right shoulder pain, weakness, and limited range of motion after a rotator cuff tear and chronic degenerative changes of the glenohumeral joint. Imaging demonstrates osteoarthritis of the humeral head and a partial-thickness rotator cuff tear. The orthopedic surgeon schedules an arthroscopic debridement with possible open conversion for subacromial decompression and repair under general anesthesia with regional block.

Perioperative workflow: preoperative anesthesia evaluation by an anesthesiologist or Certified Registered Nurse Anesthetist (CRNA) documents medical comorbidities, airway assessment, and regional block plan. On day of surgery, an interscalene brachial plexus block is performed for intraoperative and postoperative analgesia, followed by induction of general endotracheal anesthesia. The anesthesiology team provides intraoperative monitoring, hemodynamic management, and postoperative handoff to PACU staff for prolonged analgesia and recovery. Documentation includes start/stop anesthesia times, regional block details, anesthetic agents, airway device, relevant modifiers, and the primary surgical procedure (open or arthroscopic shoulder procedure). Typical facilities: ambulatory surgery centers or hospital operating rooms for orthopedic shoulder procedures. Typical payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

Coding Specifications

Modifier	Description	When to Use
`AA`	Anesthesia services performed personally by an anesthesiologist

Taxonomy Code	Specialty	Notes
`207L00000X`	Anesthesiology	Physician anesthesiologists who provide perioperative anesthesia care for shoulder procedures.
`367500000X`	Certified Registered Nurse Anesthetist	CRNAs who deliver anesthesia services, often under medical direction or supervision.
`207RA0401X`	Anesthesiology Assistant	Anesthesia assistants who participate in delivery of anesthesia under physician supervision.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M17.11`	Unilateral primary osteoarthritis, right knee	Although knee diagnosis, listed in input; not directly related to shoulder anesthesia but may indicate patient comorbid musculoskeletal disease affecting perioperative mobility and analgesic planning.
`M23.50`	Chronic instability of knee, unspecified knee	Input diagnosis; not shoulder-specific but reflects chronic joint instability; consider systemic arthritis or mobility limitations impacting perioperative care.
`S83.241A`	Tear of medial meniscus, current injury, right knee, initial encounter	Knee injury in input list; not directly tied to shoulder procedure but relevant if concurrent orthopedic procedures or overall anesthetic risk assessment.
`M25.561`	Pain in right knee	Symptom code present in input; may influence multimodal analgesia planning if patient has multiple joint pains.
`S82.101A`	Fracture of upper end of right tibia, initial encounter for closed fracture	Lower extremity fracture listed in input; relevant to overall perioperative mobility and DVT prophylaxis considerations.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`01622`	Anesthesia for diagnostic arthroscopic procedure of the shoulder joint	Used when anesthesia is provided for diagnostic arthroscopy of the shoulder; less extensive than open procedures covered by `01630`.
`01634`	Anesthesia for open or surgical arthroscopic procedure including shoulder disarticulation	Used for more extensive open or arthroplasty-level shoulder procedures; may be an alternative code when the surgical procedure scope differs from `01630`.

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Summary & Overview