Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerBilling CodesAnesthesia for Procedures on the Upper Arm and ElbowCPT cpt-01712-anesthesia-open-tenotomy-elbow-to-shoulder
    Ask Trek AI about this page

    CPT 01712: Anesthesia for Open Tenotomy, Elbow to Shoulder

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

    CPT code 01712 describes anesthesia services provided for an open tenotomy procedure in the region from the elbow to the shoulder; service type: anesthesia for open surgical tendon procedure; typical site of service: operating room or other surgical suite involving the upper extremity (elbow through shoulder).

    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.

    Customize your policy alerts

    Sign up for cpt 01712 policy alerts

    Get alerted when payer policies referencing 01712 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    National Reimbursement Benchmarks

    Commercial rates for CPT 01712 cluster around BUCA’s average commercial rate of $73.30, with notable variation across major carriers. Cigna and Aetna sit above BUCA on mean rates ($96.50 and $80.70 respectively), while Blue Cross Blue Shield and UnitedHealth Group have lower means ($65.10 and $67.40). Overall medians trend similarly: Cigna’s median of $86 exceeds BUCA’s median of $64.70, while Blue Cross Blue Shield ($56.00) and UnitedHealth Group ($63.80) remain below. These comparisons highlight that BUCA’s average represents a mid-market position among the insurers listed.

    Dispersion measured by the interquartile range (P75–P25) shows Blue Cross Blue Shield and UnitedHealth Group are the tightest markets with ranges of $36.60 and $28.90 respectively, indicating more concentrated pricing. Aetna and Cigna exhibit wider dispersion—Aetna’s IQR is $57.70 and Cigna’s is $58.40—signaling greater variability in contracted rates. BUCA’s IQR is $42.10, placing it between the tightest and widest payers.

    Table of contents

    Progress1 / 8

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools
    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 45-year-old male presents to the orthopedic surgery clinic with chronic lateral elbow pain and a tendon injury requiring an open tenotomy between the elbow and shoulder region. Preoperative evaluation identifies localized tendon pathology and persistent functional impairment after conservative care. The patient is scheduled for an open tenotomy of the distal biceps tendon performed in an ambulatory surgery center under general anesthesia with regional block for postoperative analgesia. The perioperative workflow includes pre-anesthesia evaluation by the anesthesiology team, informed consent for anesthesia, intraoperative monitoring per ASA standards, airway management and induction, maintenance of general anesthetic with supplemental peripheral nerve block (if indicated), intraoperative hemodynamic management, and postoperative transfer to the PACU for recovery and pain control prior to discharge or inpatient admission as directed by the surgical and anesthesia teams. Typical documentation includes the anesthesia preoperative assessment, ASA physical status, airway and vascular access notes, anesthetic technique (agents, doses), regional block details if performed, intraoperative events, and postoperative disposition.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    01462Anesthesia for procedures on lower leg, knee jointRelated regional anesthesia coding for lower-extremity procedures; included here as a referenced alternative region-specific anesthesia code when procedures involve lower extremity rather than upper arm/shoulder.

    Related Modifiers

    8 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…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    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
    224ZF0002X
    225CA2400X
    3747A0650X
    207VG0400X
    231HA2500X

    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-01710-UPPER-ARM-ELBOW-ANESTHESIA-SOFT-TISSUE-PROCEDURES

    CPT 01710: Anesthesia for Upper Arm and Elbow Procedures

    CPT-01714-UPPER-ARM-ELBOW-TENOPLASTY-ANESTHESIA

    CPT 01714: Anesthesia for Tenoplasty, Upper Arm and Elbow

    CPT-01716-ANESTHESIA-UPPER-ARM-ELBOW-TENODESIS-BICEPS-RUPTURE

    CPT 01716: Anesthesia for Tenodesis, Long Biceps Tendon (Upper Arm/Elbow)

    CPT-01730-ANESTHESIA-CLOSED-PROCEDURE-HUMERUS-ELBOW

    CPT 01730: Anesthesia for Closed Procedure on Humerus or Elbow

    CPT-01732-ELBOW-DIAGNOSTIC-ARTHROSCOPY-ANESTHESIA

    CPT 01732: Anesthesia for Diagnostic Elbow Arthroscopy

    CPT-01740-ANESTHESIA-ELBOW-OPEN-ARTHROSCOPIC-PROCEDURE

    CPT 01740: Anesthesia for Open or Arthroscopic Elbow Procedure

    CPT-01742-ANESTHESIA-OSTEOTOMY-HUMERUS-UPPER-ARM

    CPT 01742: Anesthesia for Humerus Osteotomy

    CPT-01744-ANESTHESIA-FOR-HUMERUS-NONUNION-MALUNION-REPAIR

    CPT 01744: Anesthesia for Humerus Nonunion/Malunion Repair

    CPT-01756-ELBOW-RADICAL-SURGERY-ANESTHESIA

    CPT 01756: Anesthesia for Radical Elbow Surgery

    CPT-01758-ANESTHESIA-EXCISION-CYST-TUMOR-HUMERUS

    CPT 01758: Anesthesia for Excision of Cyst or Tumor of Humerus

    Showing 1–10 of 15

    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.
    Published by

    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.

    01464Anesthesia for open or surgical arthroscopic procedures on knee jointRepresents anesthesia coding for knee arthroscopy; included for cross-reference to common extremity procedure anesthesia codes.
    01470Anesthesia for procedures on bones of lower leg, ankle, and footCodes anesthesia for foot/ankle surgeries; provided as related extremity anesthesia codes in the dataset for comparator use.
    01480Anesthesia for procedures on nerves, muscles, tendons, fascia, and bursae of knee and popliteal areaRelated anesthesia coding for tendon and soft-tissue procedures in a different extremity region; clinically analogous to 01712 for tendon procedures but focused on lower extremity.