Summary & Overview
CPT 01202: Anesthesia for Shoulder and Axilla Procedures
CPT 01202 designates anesthesia for procedures on the shoulder and axilla when no more specific anesthesia code applies. As an anesthesiology code commonly used in outpatient hospital settings, it captures perioperative anesthesia services for shoulder surgeries and related procedures. Nationally, accurate use of CPT 01202 matters for appropriate clinical documentation, billing consistency, and alignment with payer policies governing operative anesthesia for upper-extremity procedures.
The analysis covers coverage by major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will find an overview of payer coverage expectations, clinical contexts in which the code is applied, and comparisons to closely related shoulder procedure codes. The content summarizes typical procedural scenarios that trigger use of this anesthesia code and highlights common associated procedure codes for clinical context.
This publication provides benchmarks for coding practice, clarifies the service setting commonly used with CPT 01202, and outlines relevant billing considerations for anesthesiology teams and billing professionals. Data not available in the input is noted where applicable.
CPT Code Overview
CPT 01202 describes anesthesia services provided for procedures on the shoulder and axilla when not otherwise specified. This code applies to anesthesiology services delivered in the context of surgical or procedural care. The typical site of service for CPT 01202 is Outpatient Hospital (POS 22), reflecting common use for same-day surgical procedures on the shoulder or axillary region.
Service Type: Anesthesiology
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to the outpatient hospital ambulatory surgery unit with shoulder pathology requiring a procedure in the shoulder or axilla under anesthesia. Common presenting complaints include persistent right shoulder pain, decreased range of motion, acute injury with suspected rotator cuff tear, or shoulder instability after trauma. Preoperative evaluation documents the diagnosis (for example, rotator cuff tear M75.100, acromioclavicular sprain S43.401A, or primary osteoarthritis M19.011), airway assessment, ASA physical status (frequently P1 for a healthy patient), and plan for monitored anesthesia care or general/regional anesthesia.
The clinical workflow: the patient arrives to the outpatient hospital (POS 22) preoperative area for routine assessment and consent. Anesthesia personnel (anesthesiologist or certified registered nurse anesthetist under supervising anesthesiologist) perform the pre-anesthesia evaluation and document the planned anesthetic technique. In the operating/procedure room, the anesthesia team provides monitored anesthesia care or a regional block or general anesthetic as indicated, documents intraoperative monitoring and medications, and records the start and end times of anesthesia services. Postoperative recovery occurs in the PACU with anesthesia handoff and discharge planning for outpatient care.
Coding Specifications
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Modifiers
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QS: Monitored anesthesia care service — used to indicate monitored anesthesia care rather than general anesthesia when documentation supports MA C for the procedure. -
P1: A normal healthy patient — ASA physical status modifier indicating a healthy patient at the time of service. -
Provider taxonomies
| Taxonomy Code | Specialty |
|---|---|
207L00000X | Anesthesiology |
207LA0401X | Pain Medicine Anesthesiologist |
207LP2900X | Pediatric Anesthesiology |
These taxonomies identify the clinician types who may provide the anesthesia services documented under 01202.
Related Diagnoses
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M75.100— Unspecified rotator cuff tear or rupture of shoulderClinical relevance: Rotator cuff tears are a common indication for shoulder surgery (open or arthroscopic) and therefore a frequent diagnosis associated with anesthesia
01202. -
S43.401A— Sprain of unspecified acromioclavicular joint, initial encounterClinical relevance: Acute acromioclavicular joint sprain may require operative or procedural management with anesthesia support documented by
01202. -
M19.011— Primary osteoarthritis, right shoulderClinical relevance: Degenerative osteoarthritis of the shoulder can lead to surgical interventions or injections requiring anesthesia services described by
01202. -
M25.511— Pain in right shoulderClinical relevance: Shoulder pain is a presenting symptom prompting diagnostic or therapeutic procedures (injection, arthroscopy) that are performed under anesthesia services captured by
01202. -
S42.001A— Fracture of unspecified part of right clavicle, initial encounterClinical relevance: Clavicle fractures may necessitate operative fixation or procedures in the shoulder/axilla region with anesthesia care represented by
01202.
Related CPT Codes
| CPT Code | Description | Relationship to 01202 |
|---|---|---|
29826 | Arthroscopy, shoulder, surgical; decompression of subacromial space | Often the surgical procedure for which anesthesia 01202 is provided; anesthesia is documented for perioperative care during arthroscopic decompression. |
23412 | Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; chronic | Open rotator cuff repair is a major shoulder surgery that may require the anesthesia services represented by 01202. |
20610 | Arthrocentesis, aspiration and/or injection into a major joint or bursa | A diagnostic or therapeutic injection/aspiration of the shoulder that may be performed with monitored anesthesia care documented with 01202 when sedation or anesthesia is provided. |
29827 | Arthroscopy, shoulder, surgical; with rotator cuff repair | Arthroscopic rotator cuff repair is frequently paired with anesthesia services described by 01202 for intraoperative and perioperative anesthetic management. |
Common use patterns: 01202 is used to document anesthesia services associated with these shoulder procedures; 20610 may be used for less invasive interventions, while 23412, 29826, and 29827 represent more extensive repairs or decompressions. Codes are commonly billed together with appropriate modifiers reflecting the anesthesia service provided.
National Reimbursement Benchmarks
National commercial average (BUCA) mean rates sit materially below Medicare when comparing mean values implied here; Medicare mean rate is not provided in the input while the BUCA mean is $145.22, indicating average commercial reimbursements for this code are lower than several commercial carriers but Medicare is not available for direct numeric comparison in the input. Aetna, Cigna, and Blue Cross Blue Shield have higher mean allowed rates ($229.55, $248.87, and $211.49 respectively) than BUCA, while UnitedHealth Group’s mean ($65.60) is well below BUCA.
Dispersion measured as the inter-percentile spread (P75 − P25) is widest for Cigna (348 − 90 = 258) and Aetna (335 − 41 = 294) indicating larger variability among reported NPIs; spreads are tightest for UnitedHealth Group (75.8 − 50.33 = 25.47) and BCBS (265 − 162.75 = 102.25) relative to the others. The table and chart below present the full percentile and mean breakdown for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska demonstrates a substantial spread in reimbursement rates for CPT code 01202, particularly among commercial payers. Blue Cross Blue Shield shows the widest rate spread, with a difference of $72.70 between the 75th and 25th percentiles, while Aetna and UnitedHealth Group have minimal variation, each with a spread of $0.00. This indicates that some payers in Alaska maintain consistent rates, while others offer a broader range depending on provider contracts.
Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are significantly higher, while UnitedHealth Group and Cigna are closer to or below national benchmarks. The table and chart below present the full breakdown of payer-specific rates in Alaska for CPT code 01202.
Key Insights for Alaska
- Blue Cross Blue Shield offers the highest mean reimbursement rate for CPT 01202 in Alaska at $267.13, while UnitedHealth Group is the lowest at $75.12.
- The rate spread is widest for Blue Cross Blue Shield, with a 75th percentile of $298.50 and a 25th percentile of $225.80, indicating significant variation.
- Alaska's mean rates for most payers are notably higher than national averages, especially for Blue Cross Blue Shield and BUCA.
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