Summary & Overview
CPT 01622: Anesthesia for Diagnostic Shoulder Arthroscopy
CPT code 01622 covers anesthesia for diagnostic arthroscopic procedures of the shoulder joint, a common intervention in orthopedic and sports medicine. This code is nationally relevant as shoulder arthroscopy is frequently performed to evaluate and diagnose joint conditions, requiring specialized anesthesia care. The publication provides a comprehensive overview of the clinical context for 01622, including its use in hospital operating rooms and its importance in facilitating minimally invasive diagnostics.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will gain insight into payer coverage, typical clinical scenarios, and policy updates related to anesthesia billing for shoulder arthroscopy. The summary also highlights relevant modifiers and associated provider taxonomies, offering a clear understanding of how this code fits into broader anesthesia and orthopedic billing practices. Benchmarks and policy considerations are discussed to inform stakeholders about current trends and requirements for reporting 01622.
CPT Code Overview
CPT code 01622 is used to report anesthesia services for diagnostic arthroscopic procedures of the shoulder joint. This code applies when anesthesia is administered to facilitate minimally invasive diagnostic evaluation of the shoulder using arthroscopy. The service type is anesthesia, and the typical site of service is the operating room in a hospital setting. This procedure is essential for ensuring patient comfort and safety during diagnostic shoulder arthroscopy.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting with persistent shoulder pain, limited range of motion, or mechanical symptoms such as clicking or instability. The patient has not responded to conservative management, and diagnostic imaging suggests intra-articular pathology. The orthopedic surgeon schedules a diagnostic arthroscopic procedure of the shoulder joint to directly visualize and assess the joint structures. Anesthesia services are provided in the operating room, typically within a hospital setting, to ensure patient comfort and safety during the procedure. The anesthesia provider may be an anesthesiologist, certified registered nurse anesthetist, or anesthesiology assistant, depending on staffing and facility protocols.
Coding Specifications
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Modifiers:
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QS: Monitored anesthesia care service. Used when the anesthesia provider delivers monitored anesthesia care rather than general anesthesia. -
QX: CRNA service with medical direction by a physician. Used when a certified registered nurse anesthetist provides anesthesia under the medical direction of a physician.
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207L00000X | Anesthesiology |
367500000X | Certified Registered Nurse Anesthetist |
207RA0401X | Anesthesiology Assistant |
These taxonomies represent the specialties eligible to provide anesthesia services for this procedure.
Related Diagnoses
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M23.50: Chronic instability of knee, unspecified knee- Indicates ongoing instability in the knee joint, which may necessitate arthroscopic evaluation or intervention. While this diagnosis is knee-specific, it is relevant for arthroscopic procedures requiring anesthesia.
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M17.11: Unilateral primary osteoarthritis, right knee- Represents degenerative changes in the right knee, often leading to arthroscopic procedures for diagnosis or treatment. Anesthesia is required for these interventions.
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M17.12: Unilateral primary osteoarthritis, left knee- Similar to
M17.11, but affecting the left knee. Arthroscopic procedures for osteoarthritis may require anesthesia services.
- Similar to
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S83.241A: Other tear of lateral meniscus, current injury, right knee, initial encounter- Describes an acute meniscal tear in the right knee, commonly managed with arthroscopic surgery under anesthesia.
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S83.242A: Other tear of lateral meniscus, current injury, left knee, initial encounter- Indicates an acute meniscal tear in the left knee, also managed with arthroscopic procedures requiring anesthesia.
These diagnoses are clinically relevant as they represent conditions commonly treated with arthroscopic procedures, for which anesthesia services are coded using the primary CPT code.
Related CPT Codes
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29881: Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving)- Used for surgical arthroscopy of the knee with removal of meniscus tissue. This code is related as anesthesia services may be required for similar arthroscopic procedures, though it is specific to the knee.
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29880: Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving)- Represents surgical arthroscopy of the knee with removal of both medial and lateral meniscus. Anesthesia services for this procedure are coded similarly to shoulder arthroscopy.
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29876: Arthroscopy, knee, surgical; synovectomy, major, 2 or more compartments- Used for major synovectomy procedures during knee arthroscopy. Anesthesia is required for these procedures, making this code relevant for comparison.
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29877: Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)- Used for debridement or shaving of cartilage during knee arthroscopy. Anesthesia services are necessary, and this code is related as an alternative or additional procedure.
These codes are commonly used in workflows involving arthroscopic procedures, with anesthesia services coded separately. They may be used together or as alternatives depending on the specific joint and procedure performed.
National Reimbursement Benchmarks
For CPT code 01622, the national mean rate for BUCA (average commercial) is $114.51, which is substantially higher than the Medicare mean rate. However, Medicare data is not available in the input, so only commercial payer benchmarks are presented. Among commercial payers, Cigna has the highest mean rate at $248.88, while UnitedHealth Group is the lowest at $65.59.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Cigna shows the widest spread ($348.00 - $90.00 = $258.00), indicating greater variability in contracted rates. UnitedHealth Group has the tightest range ($75.33 - $50.20 = $25.13), suggesting more consistent reimbursement levels. The table and chart below present the full breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska demonstrates a significant spread in reimbursement rates for CPT code 01622, with Blue Cross Blue Shield showing the widest range between the 25th and 75th percentiles ($298.50 minus $225.80 equals $72.70). In contrast, Aetna, Cigna, and UnitedHealth Group all have much narrower spreads, with their 25th and 75th percentiles differing by only $3.00. This indicates that Blue Cross Blue Shield's rates are not only higher but also more variable compared to other payers in the state.
Compared to national averages, Alaska's mean rates for most payers are substantially higher, particularly for Blue Cross Blue Shield and BUCA. The table and chart below present the full breakdown of payer-specific reimbursement rates in Alaska, highlighting these differences and the overall rate distribution across the major commercial payers.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 01622 in Alaska, with a mean rate of $267.12.
- UnitedHealth Group offers the lowest mean rate at $74.78.
- Alaska's mean rates for most payers are notably higher than national averages, especially for Blue Cross Blue Shield and BUCA.
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.