CPT 01742: Anesthesia for Osteotomy of the Humerus
CPT code 01742 denotes anesthesia services provided during osteotomy of the humerus, an orthopedic surgical procedure involving excision or cutting of the upper-arm bone. Nationally, anesthesia codes for limb osteotomy are important because they capture perioperative resource use, influence anesthesia staffing and billing workflows, and factor into surgical episode cost and quality monitoring. Major commercial payers and Medicare commonly adjudicate this code for inpatient and outpatient surgical settings.
This analysis covers coverage practices for major payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, guidance on how the code relates to other upper-arm anesthesia codes, and an overview of payer coverage scope. The report outlines typical sites of service (operating room and surgical suites), common clinical scenarios prompting a humeral osteotomy, and relevant coding relationships used to group perioperative anesthesia services.
Intended for billing managers, anesthesia providers, and revenue cycle staff, the content explains what CPT code 01742 represents, where it is applied clinically, and which payers are commonly involved. Data not available in the input is noted where applicable; the focus remains on clear identification of the service, payer scope, and clinical setting implications for national audiences.
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Billing Code Overview
CPT code 01742 describes anesthesia services for osteotomy of the humerus, the long bone of the upper arm. The service type is anesthesia for upper arm/shoulder orthopedic surgery, and the typical site of service is an operating room or other inpatient/outpatient surgical suite where orthopedic procedures are performed.
Clinical & Coding Specifications
Clinical Context
A 56-year-old patient with chronic shoulder pain and deformity presents for surgical correction with an open osteotomy of the humerus to realign the proximal humerus for improved function and pain relief. The patient has failed conservative measures including physical therapy and analgesics. Preoperative assessment by the anesthesia team includes airway evaluation, review of medical comorbidities, medication reconciliation, and consent for general anesthesia with regional blockade as indicated.
On the day of surgery the patient arrives to the ambulatory surgery center or hospital operating room. The anesthesia provider (anesthesiologist, certified registered nurse anesthetist, or anesthesiology assistant) places standard monitors, establishes intravenous access, and induces general anesthesia. A peripheral nerve block (e.g., interscalene or axillary block) may be performed for intraoperative and postoperative analgesia. Intraoperative management includes airway control (endotracheal tube or laryngeal mask), maintenance of anesthesia, hemodynamic support, fluid management, and pain control. At procedure end, the anesthesia team coordinates emergence and handoff to the post-anesthesia care unit (PACU), provides analgesic plan and nerve block instructions, and documents the anesthesia time and any intraoperative events for billing using 01742 for anesthesia services for osteotomy of the humerus.
Typical site of service: hospital operating room or ambulatory surgery center.
Service type: anesthesia for major upper extremity orthopedic surgery (open osteotomy of the humerus).
Coding Specifications
- For the anesthesia service described, the following modifiers are most clinically relevant. Each modifier is CMS-standardized and applied when specific circumstances affect anesthesia billing.
| Modifier | Description | When to Use |
|---|---|---|
AA | Anesthesia services performed personally by anesthesiologist | Use when the physician anesthesiologist personally performs the anesthesia service for 01742. |
AD | Medical supervision by a physician; more than four concurrent anesthesia procedures | Use when the physician directs multiple concurrent 01742 cases and bills supervisory services. |
QK | Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals | Use when the anesthesiologist medically directs CRNAs or assistants for 01742 across 2–4 concurrent cases. |
QX | CRNA service with medical direction by a physician (modifier for CRNA) | Use when a Certified Registered Nurse Anesthetist performs 01742 under physician direction. |
QY | Medical direction of one certified registered nurse anesthetist by an anesthesiologist | Use when the anesthesiologist directs one CRNA for the 01742 case. |
QZ | CRNA service without medical direction by a physician | Use when a CRNA provides 01742 independently (no physician direction). |
62 | Two surgeons | Use when two surgeons are required for the osteotomy and both share primary surgical responsibilities; appended as appropriate to the surgical code and noted in anesthesia documentation. |
78 | Return to the operating room for a related procedure during the postoperative global period | Use if the patient returns to the OR for a complication related to the 01742 osteotomy and anesthesia is provided for the return procedure. |
53 | Discontinued procedure | Use when the anesthesia service for 01742 is terminated before completion due to patient condition or other intraoperative issue. |
23 | Unusual anesthesia | Use when the procedure 01742 requires general anesthesia in circumstances where local/regional typically would be used, due to patient condition or emergency. |
22 | Increased procedural services | Use to report when the anesthesia service for 01742 requires substantially greater work than typical and documentation supports unusual effort. |
50 | Bilateral procedure | Use when bilateral procedures are performed, if clinically applicable and supported by operative report (rare for humeral osteotomy). |
56 | Preoperative or postoperative care by another physician | Use when another physician provides preoperative evaluation or postoperative management distinct from the anesthesia provider billing 01742. |
78 | Return to OR for related procedure during global period | Use when anesthesia is provided for a repeat operation related to the index 01742 case. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Anesthesiology | Physicians specializing in perioperative anesthesia who commonly bill 01742. |
367500000X | Certified Registered Nurse Anesthetist | CRNAs who may provide or assist with anesthesia for 01742 under applicable supervision rules. |
207RA0401X | Anesthesiology Assistant | Anesthesiology assistants who participate in anesthesia delivery for 01742 under anesthesiologist direction. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M23.50 | Chronic instability of knee, unspecified knee | Not directly related to humeral osteotomy; present in the input list but would be unrelated comorbidity if documented concurrently. |
M17.11 | Unilateral primary osteoarthritis, right knee | Knee osteoarthritis is not an indication for humeral osteotomy; if present, it represents a concurrent musculoskeletal diagnosis in the patient. |
M17.12 | Unilateral primary osteoarthritis, left knee | As above, a concurrent comorbidity not directly related to 01742. |
S83.241A | Other tear of medial meniscus, current injury, right knee, initial encounter | Knee meniscal tear is unrelated to humeral osteotomy; may represent coexisting orthopedic pathology in the same patient. |
S83.242A | Other tear of medial meniscus, current injury, left knee, initial encounter | As above, represents concurrent knee injury but not an indication for humeral osteotomy. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
01740 | Anesthesia for procedures on the upper arm and elbow | Related anesthesia code covering other upper arm/elbow procedures; used if osteotomy involves adjacent anatomic zones or alternative coding is appropriate. |
01744 | Anesthesia for procedures on the upper arm and elbow | Related anesthesia code for upper arm/elbow procedures; used for variations in surgical approach or coding specificity relative to 01742. |