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.
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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 & Coding Specifications
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 | Use when the physician anesthesiologist personally performs the anesthesia. |
AD | Medical supervision by a physician; more than four concurrent anesthesia procedures | Use when supervising more than four concurrent anesthesia cases. |
QK | Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals | Use when the anesthesiologist medically directs CRNAs/assistants for 2–4 concurrent cases. |
QS | Monitored anesthesia care (MAC) service | Use when MAC is provided instead of general or regional anesthesia. |
QX | CRNA service performed under physician supervision | Use when CRNA performs service under physician direction and reported separately where allowed. |
QY | Medical direction of one CRNA by an anesthesiologist | Use when anesthesiologist directs a single CRNA for the case. |
23 | Unusual anesthesia (e.g., emergency or special circumstances) | Use for procedures that require unusually high anesthesia due to emergency or complexity. |
62 | Two surgeon team (co-surgeons) | Use when two surgeons perform distinct surgical work; may affect anesthesia planning when prolonged or complex. |
78 | Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period | Use when patient returns to OR for complications related to prior shoulder surgery. |
50 | Bilateral procedure | Use when bilateral shoulder procedures are performed (rare for this code focused on unilateral shoulder). |
| 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. |