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    v1.0.30
    OpenPayerBilling CodesAnesthesia for Procedures on the Shoulder and AxillaCPT cpt-01638-shoulder-joint-replacement-anesthesia
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    CPT 01638: Anesthesia for Shoulder Joint Replacement

    Commercial payers pay $73 on average nationally for this procedure.

    CPT code 01638 describes anesthesia services provided for a patient undergoing replacement of the shoulder joint, representing perioperative anesthesia care for shoulder arthroplasty procedures; service type: anesthesia for joint replacement; typical site of service: hospital operating room or ambulatory surgical center during shoulder joint replacement 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

    National commercial reimbursements for CPT 01638 cluster around the BUCA average commercial rate of $72.80, with notable variation across major carriers. Blue Cross Blue Shield (BCBS) shows a lower central tendency (median $51) and a moderate upper spread to the 75th percentile at $73.50, while Cigna and Aetna sit substantially higher in medians and means (Cigna median $85.7, Aetna median $85.6). UnitedHealth Group’s median of $63.5 and mean of $67.10 place it between BCBS and the higher-paying carriers, and BUCA’s mean denotes the average commercial level for benchmarking.

    Evaluating dispersion (P75 minus P25) highlights differences in pricing stability: Aetna’s interquartile range is $81.30 ($126.80 − $45.00), the widest, indicating more variability among contracted rates. Cigna follows with a range of $52.20 ($119.90 − $67.80). Blue Cross Blue Shield is relatively tighter at $32.20 ($73.50 − $41.30), and UnitedHealth Group shows the narrowest spread at $29.10 ($80.40 − $51.30), suggesting more consistent commercial payments within that plan population.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old male with a history of peripheral vascular disease (I73.9), bilateral intermittent claudication due to atherosclerosis of the native arteries of the lower extremities (I70.203, I70.213, I70.214), and a prior embolic event (I74.3) presents for scheduled total shoulder arthroplasty for advanced glenohumeral osteoarthritis. The anesthesiologist (or Certified Registered Nurse Anesthetist under direction) performs general endotracheal anesthesia with an interscalene regional block for postoperative analgesia. Preoperative evaluation includes cardiovascular risk assessment given peripheral vascular disease and embolic history, review of anticoagulation status, and documentation of informed consent for anesthesia. Intraoperative workflow includes induction, airway management, intraoperative hemodynamic monitoring, administration of anesthetic agents, regional block placement under ultrasound guidance, and management of fluid and blood loss. Postoperative care includes emergence, transfer to PACU with pain and neurovascular monitoring, documentation of anesthesia time, any intraoperative complications, and application of appropriate modifiers for unusual services or concurrent conditions.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure

    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…
    54Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207L00000X
    207LA0401X
    367500000X
    246RM2200X
    171WH0202X
    246X00000X
    282NC2000X
    225500000X

    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-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-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 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.

    35371Thrombectomy, open, including patch graft, if performed; popliteal-tibial or popliteal-peroneal-tibialRelevant vascular surgical option for lower-extremity arterial embolism/thrombosis; may be performed in the same patient population pre- or post-orthopedic procedures when limb ischemia is present.
    37225Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateralEndovascular revascularization used to treat peripheral arterial disease and intermittent claudication; may be part of staged care in patients with significant peripheral vascular disease undergoing major surgery.
    36245Selective catheter placement, arterial system; each first-order thoracic or brachiocephalic branch, within a vascular familyDiagnostic/therapeutic arterial catheterization code used in vascular interventions for patients with embolic disease; relevant to preoperative vascular evaluation or intervention.
    93925Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral studyNoninvasive vascular study commonly used to assess peripheral arterial disease severity preoperatively and guide timing of elective orthopedic surgery.