Summary & Overview
CPT 01634: Anesthesia for Shoulder Disarticulation Procedures
CPT code 01634 represents anesthesia for complex shoulder procedures, including shoulder disarticulation, and is a critical billing code for anesthesiology services in surgical settings. This code is nationally relevant due to its application in major orthopedic and trauma surgeries, where precise anesthesia management is essential for patient safety and surgical outcomes. The publication covers key payers such as Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, providing a comprehensive overview of payer coverage and policy considerations for this anesthesia service.
Readers will gain insight into the clinical context of 01634, including its typical use in inpatient hospital environments and its role in supporting surgical teams during high-risk procedures. The summary also highlights common modifiers and associated taxonomies, offering clarity on billing practices and provider qualifications. Additionally, the publication addresses relevant ICD-10 diagnoses and related CPT codes, equipping stakeholders with the information needed to understand coding benchmarks and policy updates. This resource is designed for healthcare professionals, billing specialists, and policy analysts seeking authoritative information on anesthesia coding for shoulder disarticulation procedures.
CPT Code Overview
CPT code 01634 is used to report anesthesia services for open or surgical arthroscopic procedures involving the humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint, specifically for shoulder disarticulation. This code is classified under the anesthesia service type and is most commonly performed in an inpatient hospital setting (Place of Service 21). The procedure requires specialized anesthesia care due to the complexity and invasiveness of shoulder disarticulation surgeries.
Clinical & Coding Specifications
Clinical Context
A patient is admitted to an inpatient hospital for a complex shoulder procedure, such as a shoulder disarticulation, due to severe joint disease or trauma. The patient may have a history of osteoarthritis or previous joint replacement. An anesthesiology provider, such as a physician anesthesiologist or a Certified Registered Nurse Anesthetist (CRNA), administers anesthesia for the open or surgical arthroscopic procedure involving the humeral head and neck, sternoclavicular joint, acromioclavicular joint, or shoulder joint. The clinical workflow includes preoperative assessment, anesthesia induction, intraoperative monitoring, and postoperative care in the hospital setting.
Coding Specifications
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Modifiers:
QS: Monitored anesthesia care service. Used when the anesthesia provider is present and monitoring the patient, but not providing general anesthesia.QX: CRNA service with medical direction by a physician. Used when a CRNA is providing anesthesia under the supervision of a physician anesthesiologist.
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207L00000X | Anesthesiology |
207LA0401X | Pain Medicine (Anesthesiology) |
367500000X | Certified Registered Nurse Anesthetist |
- Specialties Represented:
- Anesthesiology: Physicians specializing in anesthesia care.
- Pain Medicine (Anesthesiology): Physicians with additional expertise in pain management.
- Certified Registered Nurse Anesthetist: Advanced practice nurses specializing in anesthesia.
Related Diagnoses
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M17.10: Unilateral primary osteoarthritis, unspecified knee- Indicates osteoarthritis in one knee, not specified as right or left. Relevant for patients with joint disease who may require surgical intervention.
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M17.11: Unilateral primary osteoarthritis, right knee- Specifies osteoarthritis in the right knee. May be part of a broader joint disease history leading to shoulder surgery.
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M17.12: Unilateral primary osteoarthritis, left knee- Specifies osteoarthritis in the left knee. Relevant for patients with multiple joint involvement.
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M17.5: Other unilateral secondary osteoarthritis of knee- Indicates secondary osteoarthritis in one knee, possibly due to trauma or other conditions. May reflect comorbidities in patients undergoing shoulder procedures.
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Z96.651: Presence of right artificial knee joint- Indicates the patient has a prosthetic knee joint. Suggests prior joint replacement, which may be associated with the need for further orthopedic interventions such as shoulder disarticulation.
Related CPT Codes
01636: Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; interthoracoscapular (forequarter) amputation
Relation to Primary CPT Code:
01636is used for anesthesia services during a more extensive procedure (forequarter amputation) involving the shoulder region, compared to01634which is for shoulder disarticulation.- These codes are alternatives depending on the surgical procedure performed. They are not typically used together but may be selected based on the specific operative intervention.
National Reimbursement Benchmarks
National mean rates for CPT code 01634 show that commercial payers such as Blue Cross Blue Shield and Cigna have significantly higher average reimbursement levels compared to UnitedHealth Group and BUCA. The mean rate for BUCA, representing the average commercial benchmark, is $202.99, while UnitedHealth Group is notably lower at $65.63. Blue Cross Blue Shield and Cigna both exceed $490, highlighting substantial variation among commercial payers.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies widely. UnitedHealth Group has the tightest range at $25.25, indicating less variability in rates. In contrast, Cigna exhibits the widest dispersion at $690.50, followed by Aetna at $480.00, suggesting greater variability in contracted rates. Blue Cross Blue Shield and BUCA also show considerable spread, with ranges of $328.60 and $280.17, respectively.
The table and chart below present a detailed breakdown of national mean rates and percentile distributions for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska demonstrates a substantial rate spread for CPT code 01634, particularly among Blue Cross Blue Shield, where the difference between the 75th and 25th percentiles is $336.27. This indicates significant variability in reimbursement depending on provider contracts. Other payers, such as Aetna and UnitedHealth Group, show minimal spread, with all percentiles clustered closely together, suggesting more uniform rates.
Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are notably higher, while Cigna and UnitedHealth Group are only slightly above or near national benchmarks. The table and chart below present the full breakdown of payer-specific rates for Alaska, highlighting these differences and the overall premium market for this code in the state.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 01634 in Alaska, with a mean rate of $613.51.
- UnitedHealth Group offers the lowest mean rate at $74.78.
- Alaska's mean rates for most payers, especially BCBS and BUCA, are significantly higher than their respective national averages, indicating a premium market for this code.
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.