Summary & Overview
CPT 21700: Scalenus Anticus Muscle Division for Neck Nerve Compression
CPT code 21700 denotes surgical division of the scalenus anticus muscle to relieve scalenus anticus syndrome, a painful condition caused by muscular compression of adjacent nerves. Nationally, this code represents a specific, targeted cervical soft-tissue surgical service performed by otolaryngology, head and neck, or peripheral nerve surgery specialists. The procedure matters because it addresses a defined anatomical cause of neurogenic or myofascial pain and influences utilization of operative outpatient and inpatient resources.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and the operational framing needed for billing and coding workflows. The publication outlines common payment and coverage considerations, variation in payer handling, and benchmarking context where available. Additionally, readers will gain insight into documentation elements and coding alignment relevant to surgical release of the scalenus anticus muscle. Data not available in the input will be identified as such in relevant sections.
Billing Code Overview
CPT code 21700 describes a surgical procedure in which a provider divides the scalenus anticus muscle at the side of the neck to treat scalenus anticus syndrome. This procedure is performed to relieve painful compression of nearby nerves caused by the scalenus anticus muscle.
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Service type: Surgical procedure, neck muscle release
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 42-year-old patient presents to an otolaryngology or neurosurgery clinic with months of unilateral neck pain, radiating paresthesia into the ipsilateral upper extremity, and weakness that worsens with arm elevation and certain neck positions. Conservative care including physical therapy, activity modification, and selective scalene muscle injections provided temporary or incomplete relief. Clinical examination demonstrates reproduction of symptoms with scalene muscle stretch and localized tenderness over the lateral neck. Imaging and electrodiagnostic testing exclude cervical radiculopathy from disc disease and identify neurovascular compression consistent with scalenus anticus (anterior scalene) syndrome. After multidisciplinary evaluation and informed consent, the patient is scheduled for operative division (scalenectomy/scalenotomy) of the scalenus anticus muscle to decompress the brachial plexus elements.
Typical workflow: Preoperative evaluation and clearance; surgical time-out; general endotracheal anesthesia; small transverse or oblique neck incision over the anterior scalene region; careful dissection to identify the anterior scalene muscle, phrenic nerve, and brachial plexus; division or partial excision of the scalenus anticus muscle; hemostasis and layered closure. Postoperative monitoring for respiratory compromise, diaphragmatic dysfunction (phrenic nerve), hematoma, and pain control; discharge same day or after overnight observation depending on comorbidities. Follow-up with wound check and physical therapy as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 |