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    OpenPayerBilling CodesAnesthesia for Procedures on the Shoulder and AxillaCPT cpt-01634-shoulder-anesthesia-open-arthroscopic-shoulder-procedures
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    CPT 01634: Anesthesia for Open or Arthroscopic Shoulder Procedures

    Commercial payers pay $66 on average nationally for this procedure.

    CPT code 01634 describes anesthesia services provided for open or surgical arthroscopic procedures involving the humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint, including shoulder disarticulation; this represents anesthesia for upper extremity/shoulder surgical procedures and is typically delivered in operating room or surgical center settings as a general or regional anesthesia service for orthopedic shoulder surgery.

    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

    Across national commercial contracts for CPT 01634, BUCA’s mean commercial rate sits at $66.40 as a practical market average. Blue Cross Blue Shield shows a broad spread between its 25th and 75th percentiles ($41.50 to $75.00), while Cigna’s center is higher (median $85.70) and its upper tail extends to a $147.40 90th percentile. UnitedHealth Group and Aetna occupy mid-to-upper ranges with UnitedHealth Group median $63.70 and Aetna median $48.00; Cigna posts the highest mean at $93.40.

    Measuring dispersion via P75 minus P25 highlights which payers are tightest and widest. Aetna’s interquartile range is $28.50, UnitedHealth Group’s is $26.40, Blue Cross Blue Shield’s is $33.50, Cigna’s is $52.00, and BUCA’s is $34.10 — Cigna is the widest (IQR $52.00) and UnitedHealth Group the tightest (IQR $26.40). These differences indicate variable variability in contracted commercial rates across payers.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 67-year-old patient with progressive right shoulder pain and limited range of motion is scheduled for an open shoulder arthroplasty for advanced glenohumeral osteoarthritis and associated rotator cuff arthropathy. The patient has failed conservative measures including physical therapy, intra-articular injections, and analgesics. Preoperative assessment by the anesthesia team documents coronary artery disease controlled on medication and an ASA physical status of P3. On the day of surgery the anesthesia provider performs general endotracheal anesthesia with interscalene regional block for postoperative analgesia. Intraoperative management includes airway control, invasive blood pressure monitoring per institutional protocol, anesthetic maintenance with volatile agent and short-acting opioid, and regional block catheter placement for postoperative pain control. Postoperatively the patient is transferred to the post-anesthesia care unit (PACU) with handoff to nursing and an acute pain service, and the regional catheter is managed for 48–72 hours as indicated. Documentation includes start and stop times for anesthesia, intraoperative events, regional block consent and technique, and any applicable modifier application (for example 22 for unusually complex anesthesia management if justified).

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    01636Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; interthoracoscapular (forequarter) amputation

    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
    2084H0002X
    207KI0005X
    364SM0705X
    208VP0000X
    221700000X

    Related ICD-10-CM Codes

    26 rows

    ICD-10-CM CodeDescription
    M13.10Monoarthritis, not elsewhere classified, unspecified site
    M17.10Unilateral primary osteoarthritis, unspecified knee
    M17.11Unilateral primary osteoarthritis, right knee
    M17.12Unilateral primary osteoarthritis, left knee
    M17.5Other unilateral secondary osteoarthritis of knee
    M19.011Primary osteoarthritis, right shoulder
    M24.211Disorder of ligament, right shoulder
    M25.419Effusion, unspecified shoulder
    M25.511Pain in right shoulder
    M25.512Pain in left shoulder

    Showing 1–10 of 26

    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-01610-SHOULDER-AXILLA-ANESTHESIA-SERVICES

    CPT 01610: Anesthesia for Shoulder and Axilla Procedures

    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-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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    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.

    Related code for a more extensive amputation procedure involving the shoulder girdle; used when the surgical procedure performed differs in scope from 01634.