Summary & Overview
CPT 01636: Anesthesia for Procedures on the Shoulder and Axilla
CPT code 01636 represents anesthesia services for procedures on the shoulder and axilla, a critical component in surgical care for patients undergoing operations in these regions. This code is widely recognized across major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, ensuring broad coverage and reimbursement for providers delivering these specialized anesthesia services.
The publication provides a comprehensive overview of 01636, detailing its clinical context, typical site of service, and its role within the broader anesthesiology service line. Readers will gain insight into payer coverage, common billing modifiers such as QS and QX, and associated provider taxonomies. Additionally, the article highlights relevant ICD-10 diagnoses frequently linked to procedures requiring anesthesia in the shoulder and axilla, such as atherosclerosis and peripheral vascular disease. Related CPT codes are also discussed to clarify distinctions in anesthesia billing for similar procedures.
This summary equips healthcare professionals, billing specialists, and policy analysts with the latest benchmarks and policy updates surrounding 01636, supporting accurate coding and understanding of its national significance in surgical anesthesia care.
CPT Code Overview
CPT code 01636 is used to report anesthesia services for procedures performed on the shoulder and axilla. This code falls under the anesthesiology service type and is most commonly utilized in the inpatient hospital setting (Place of Service 21). The code is essential for accurately documenting and billing anesthesia care provided during surgical interventions involving the shoulder and axillary regions.
Clinical & Coding Specifications
Clinical Context
A patient is admitted to an inpatient hospital (Place of Service 21) for a surgical procedure involving the shoulder or axilla. The patient may have underlying vascular conditions such as peripheral vascular disease or atherosclerosis, which necessitate surgical intervention. An anesthesiologist or a certified registered nurse anesthetist (CRNA) provides anesthesia services for the procedure, ensuring the patient is safely sedated and pain-free throughout the operation. The clinical workflow includes preoperative assessment, administration of anesthesia, intraoperative monitoring, and postoperative care.
Coding Specifications
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Modifiers:
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 CRNA provides anesthesia under the supervision of a physician.
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207L00000X | Anesthesiology |
207V00000X | Vascular Surgery |
207P00000X | Emergency Medicine Physician |
These taxonomies represent the specialties eligible to provide or direct anesthesia services for shoulder and axilla procedures.
Related Diagnoses
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I70.203: Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs- Relevant for patients with vascular disease affecting both legs, which may necessitate surgical intervention involving the shoulder or axilla.
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I73.9: Peripheral vascular disease, unspecified- Indicates general peripheral vascular disease, a common comorbidity in patients undergoing vascular or orthopedic procedures.
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I74.3: Embolism and thrombosis of arteries of the lower extremities- Represents acute vascular events that may require urgent surgical management and anesthesia.
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I70.213: Atherosclerosis of native arteries of extremities with intermittent claudication, right leg- Specifies vascular disease in the right leg, relevant for surgical planning and anesthesia risk assessment.
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I70.214: Atherosclerosis of native arteries of extremities with intermittent claudication, left leg- Specifies vascular disease in the left leg, also relevant for perioperative management and anesthesia considerations.
Related CPT Codes
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01634: ANESTHESIA ARTHROSCOPIC SHOULDER DISARTICULATION- Used for anesthesia during arthroscopic shoulder disarticulation procedures. Related to
01636as both involve anesthesia for shoulder surgeries, but01634is specific to disarticulation.
- Used for anesthesia during arthroscopic shoulder disarticulation procedures. Related to
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01638: ANES ARTHRS INTERTHORACOSCAPULAR AMPUTATION- Used for anesthesia during interthoracoscapular amputation procedures. This code is related to
01636as it covers anesthesia for more extensive shoulder and axilla surgeries.
- Used for anesthesia during interthoracoscapular amputation procedures. This code is related to
These codes may be used as alternatives depending on the specific surgical procedure performed. They are not typically billed together but are selected based on the operative technique and extent of surgery.
National Reimbursement Benchmarks
For CPT code 01636, national mean rates among commercial payers show significant variation. The average rate for BUCA (the composite of major commercial payers) is $287.47, while individual commercial payers range from $65.61 for UnitedHealth Group to $810.35 for Cigna. Medicare rates are not available in the input for comparison.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, is widest for Cigna ($1,209.67) and BCBS ($455.26), indicating substantial variability in contracted rates. UnitedHealth Group has the tightest range ($25.08), 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 exhibits a wide spread in reimbursement rates for CPT code 01636, with Blue Cross Blue Shield showing the largest rate range (75th percentile minus 25th percentile: $320.90), while Aetna, Cigna, and UnitedHealth Group have minimal spreads, all clustered closely around $72–$93. The BUCA composite also demonstrates a substantial spread of $505.13, indicating significant variability among commercial payers in the state.
Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are notably higher, while Cigna and UnitedHealth Group are below their respective national benchmarks. The table and chart below present the full breakdown of payer-specific rates in Alaska for CPT code 01636.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 01636 in Alaska, with a mean rate of $935.15.
- UnitedHealth Group offers the lowest mean rate at $74.78.
- Alaska's mean rates for most payers, especially Blue Cross Blue Shield and BUCA, are significantly higher than national averages, while Cigna and UnitedHealth Group are below national benchmarks.
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.