Summary & Overview
CPT 00450: Anesthesia for Clavicle and Scapula Procedures
CPT code 00450 covers anesthesia for procedures performed on the clavicle and scapula, a critical area in orthopedic and trauma surgery. This code is widely used by anesthesiology professionals in outpatient hospital settings, reflecting its importance in both routine and complex shoulder surgeries. Nationally, the code is recognized by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, ensuring broad coverage for patients undergoing these procedures.
The publication provides a comprehensive overview of 00450, including payer coverage, clinical context, and relevant billing modifiers. Readers will gain insight into typical use cases, associated diagnoses, and related CPT codes, offering a clear understanding of how this code fits into the broader landscape of anesthesia billing. Policy updates and benchmarks are also discussed, equipping healthcare professionals and administrators with the information needed to navigate reimbursement and compliance for anesthesia services on the clavicle and scapula. The analysis highlights the significance of accurate coding and documentation, supporting efficient claims processing and quality patient care.
CPT Code Overview
CPT code 00450 is designated for anesthesia services provided during procedures involving the clavicle and scapula. This code falls under the anesthesiology service type and is most commonly utilized in the outpatient hospital setting, specifically at Place of Service 22. The code is essential for accurately capturing anesthesia care for a range of surgical interventions on the shoulder girdle, ensuring proper documentation and billing for these specialized procedures.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting to the outpatient hospital with acute pain and limited mobility in the right shoulder following a fall. Imaging reveals a fracture of the right clavicle (S42.001A) and possible rotator cuff tear (M75.100). The patient is scheduled for surgical repair of the clavicle, requiring anesthesia services for the procedure. An anesthesiologist or a certified registered nurse anesthetist (CRNA) provides anesthesia care, ensuring patient comfort and safety throughout the operation. The clinical workflow includes preoperative assessment, administration of anesthesia, intraoperative monitoring, and postoperative recovery in the outpatient setting.
Coding Specifications
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Modifiers:
QS: Monitored anesthesia care service. Used when the anesthesia provider delivers monitored anesthesia care (MAC) during the procedure.QX: CRNA service with medical direction by a physician. Used when a CRNA provides anesthesia under the medical direction of an anesthesiologist.
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Provider Taxonomies:
Taxonomy Code Specialty Name 207L00000XAnesthesiology 367500000XCertified Registered Nurse Anesthetist (CRNA) 207RA0401XAnesthesiology Assistant -
Service Type:
- Anesthesiology
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Typical Site of Service:
- Outpatient Hospital (POS 22)
Related Diagnoses
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M75.100: Unspecified rotator cuff tear or rupture of shoulder- Relevant for patients undergoing clavicle or scapula procedures due to associated shoulder injuries.
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S43.401A: Sprain of unspecified acromioclavicular joint, initial encounter- Indicates acute injury to the acromioclavicular joint, often requiring surgical intervention and anesthesia.
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M19.011: Primary osteoarthritis, right shoulder- Chronic degenerative condition that may necessitate surgical procedures on the clavicle or scapula.
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S42.001A: Fracture of unspecified part of right clavicle, initial encounter- Directly related to procedures on the clavicle, commonly requiring anesthesia services.
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M25.511: Pain in right shoulder- Symptom code that may be associated with underlying conditions requiring surgical intervention on the clavicle or scapula.
Related CPT Codes
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00400: Anesthesia for procedures on integumentary system on the extremities, anterior trunk and perineum.- Used for anesthesia services during procedures involving skin and soft tissue on the extremities, trunk, or perineum. May be used as an alternative when the procedure is not specific to the clavicle or scapula.
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00454: Anesthesia for procedures on clavicle and scapula (biopsy procedure).- Specifically used when the procedure involves a biopsy of the clavicle or scapula. This code is related to
00450but is more specific to biopsy procedures.
- Specifically used when the procedure involves a biopsy of the clavicle or scapula. This code is related to
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00470: Anesthesia for partial rib resection.- Used for anesthesia during partial rib resection procedures. This code may be used in cases where the surgical procedure extends to the ribs, and is an alternative to
00450when the focus is on rib resection rather than clavicle or scapula.
- Used for anesthesia during partial rib resection procedures. This code may be used in cases where the surgical procedure extends to the ribs, and is an alternative to
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Clinical Workflow Relation:
00400,00454, and00470are related to00450as anesthesia codes for procedures in the same anatomical region.00454is commonly used together with00450when a biopsy is performed, while00400and00470are alternatives depending on the specific surgical procedure.
National Reimbursement Benchmarks
National mean rates for CPT code 00450 show that commercial payers (BUCA) average $168.91, while Medicare rates are not available in the input. Among individual commercial payers, Cigna has the highest mean rate at $298.29, followed by Blue Cross Blue Shield at $279.10 and Aetna at $249.04. UnitedHealth Group is notably lower at $65.63.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly. Cigna exhibits the widest spread ($433.00 - $88.00 = $345.00), indicating substantial variability in reimbursement. UnitedHealth Group has the tightest range ($75.80 - $50.33 = $25.47), suggesting more consistent rates. Blue Cross Blue Shield and Aetna also show considerable dispersion, while BUCA's range is moderate.
The table and chart below present a detailed breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a wide spread in reimbursement rates for CPT code 00450, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($96.90), while Aetna, Cigna, and UnitedHealth Group display minimal spreads ($0–$8). This indicates that Blue Cross Blue Shield's rates are more variable, whereas other payers maintain consistent rates across providers. Compared to national averages, Blue Cross Blue Shield and BUCA payers in Alaska offer higher mean rates, while Cigna and UnitedHealth Group are notably below their national benchmarks.
The table and chart below present the full breakdown of mean rates and percentile distributions for each payer in Alaska, highlighting the differences in reimbursement levels and variability across the market.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 00450 in Alaska, with a mean rate of $329.81.
- UnitedHealth Group offers the lowest mean rate in Alaska at $75.12.
- Cigna's mean rate in Alaska ($89.33) is significantly below its national average ($298.29), while Blue Cross Blue Shield's mean rate in Alaska is notably above its national average ($279.10).
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.