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    v1.0.30
    OpenPayerBilling CodesAnesthesia for Procedures on the Shoulder and AxillaCPT cpt-01654-shoulder-axilla-artery-bypass-anesthesia
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    CPT 01654: Anesthesia for Bypass Graft of Shoulder/Axilla Arteries

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

    CPT code 01654 describes anesthesia services provided for a patient undergoing a bypass graft procedure on the arteries of the shoulder and axilla; service type: anesthesia for vascular bypass surgery on the upper extremity/shoulder girdle; typical site of service: operating room or surgical suite in an acute care hospital or ambulatory surgical center.

    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 rates for CPT 01654 cluster around BUCA’s average commercial benchmark of $66.5, with notable variation across major payers. Blue Cross Blue Shield shows a wide distribution (P75–P25 = $75.2 - $41.7 = $33.5), while Cigna’s distribution is similarly broad (P75–P25 = $120.0 - $67.9 = $52.1), driven by a high mean and high upper-percentile values. Aetna and UnitedHealth Group present tighter spreads: Aetna’s P75–P25 = $72.0 - $42.0 = $30.0 and UnitedHealth Group’s P75–P25 = $80.9 - $51.4 = $29.5, indicating relatively more concentrated commercial reimbursement ranges.

    Median and mean positioning further differentiates payers: Cigna’s median of $85.7 and mean of $93.7 sit well above BUCA’s $66.5 average, while Blue Cross Blue Shield and UnitedHealth Group medians ($51.5 and $63.7) are closer to BUCA. Aetna’s median of $48.0 is below BUCA, and both Blue Cross Blue Shield and Aetna have higher maximums ($187.3 and $137.3) suggesting occasional outlier contractual rates. These differences underscore payer-specific dispersion and central tendency in commercial reimbursements for this CPT.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old patient with symptomatic right upper extremity ischemia due to axillary-subclavian arterial occlusive disease presents for surgical bypass grafting of the shoulder/axillary arteries. Preoperative evaluation documents controlled hypertension and Type 2 diabetes; ASA physical status P3. The patient is admitted through the hospital surgical service and scheduled for vascular bypass grafting under general anesthesia with possible regional block for postoperative analgesia. The anesthesia team (anesthesiologist with CRNA or anesthesiology assistant) performs preoperative assessment, reviews anticoagulation and vascular imaging, establishes intraoperative monitoring including arterial line, induces general anesthesia, manages hemodynamics during arterial clamping and grafting, provides blood product management if needed, and coordinates postoperative handoff to PACU or ICU. Typical intraoperative events include periods of significant hemodynamic variation during vessel manipulation and potential need for intraoperative anticoagulation reversal or transfusion. Postoperatively the patient is monitored for graft patency, neurovascular status of the upper extremity, and pain control before transfer to a monitored bed.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    01402Anesthesia for open or surgical arthroscopic procedures on knee jointRelated code listed in input; not typically used for axillary/shoulder bypass—included in input as related vascular/orthopedic anesthesia codes.

    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
    367500000X
    207RA0401X
    2278P4000X
    156FX1800X
    204D00000X
    1223D0001X
    246X00000X

    Related ICD-10-CM Codes

    32 rows

    ICD-10-CM CodeDescription
    G45.8Other transient cerebral ischemic attacks and related syndromes
    G45.9Transient cerebral ischemic attack, unspecified
    I70.231Atherosclerosis of native arteries of right leg with ulceration of thigh
    I70.232Atherosclerosis of native arteries of right leg with ulceration of calf
    I70.233Atherosclerosis of native arteries of right leg with ulceration of ankle
    I70.239Atherosclerosis of native arteries of right leg with ulceration of unspecified site
    I70.241Atherosclerosis of native arteries of left leg with ulceration of thigh
    I70.242Atherosclerosis of native arteries of left leg with ulceration of calf
    I70.243Atherosclerosis of native arteries of left leg with ulceration of ankle
    I70.249Atherosclerosis of native arteries of left leg with ulceration of unspecified site

    Showing 1–10 of 32

    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-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-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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    01444Anesthesia for procedures on knee joint; total knee arthroplastyRelated code listed in input; represents anesthesia for major joint procedures and is provided for cross-reference of anesthesia coding for large extremity surgeries.
    20610Arthrocentesis, aspiration and/or injection, major joint or bursaRelated code listed in input; relevant when intraoperative or perioperative joint injection or aspiration is performed, though not typical for axillary arterial bypass.
    29881Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving)Related code listed in input; included as related extremity surgical procedures whose anesthesia requirements may be comparable in complexity.