Summary & Overview
CPT 01680: Anesthesia for Shoulder Cast Application, Removal, or Repair
CPT code 01680 covers anesthesia services for procedures on the shoulder and axilla, specifically for shoulder cast application, removal, or repair not otherwise classified under another anesthesia code. This code is significant for hospitals and anesthesia providers, as it ensures accurate billing for specialized orthopedic procedures requiring anesthesia. The service is typically rendered in outpatient hospital settings, reflecting the growing trend toward ambulatory care for musculoskeletal interventions.
Major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare recognize and reimburse for CPT code 01680, making it relevant for providers across the country. The publication provides an overview of payer coverage, clinical context, and policy updates related to this code. Readers will gain insight into the typical use cases, associated service types, and the importance of proper coding for anesthesia in orthopedic procedures. The summary also highlights common modifiers and taxonomies relevant to anesthesia billing, as well as related ICD-10 diagnoses and CPT codes that may be encountered in clinical practice. This information is essential for healthcare administrators, billing professionals, and clinicians seeking to stay informed about anesthesia coding standards and payer requirements.
CPT Code Overview
CPT code 01680 is designated for anesthesia services provided during procedures involving the shoulder and axilla, specifically for shoulder cast application, removal, or repair when not described by another anesthesia code. This code falls under the anesthesia service type and is most commonly utilized in the outpatient hospital setting (Place of Service 22). The code ensures appropriate billing and documentation for anesthesia care during these specialized orthopedic interventions.
Clinical & Coding Specifications
Clinical Context
A patient presents to the outpatient hospital with a shoulder injury or condition requiring immobilization. The orthopedic team determines that a shoulder cast must be applied, removed, or repaired. Due to the complexity or patient factors (such as pain, anxiety, or medical comorbidities), anesthesia services are required to safely perform the cast procedure. An anesthesiologist or certified registered nurse anesthetist (CRNA) provides anesthesia care during the shoulder cast application, removal, or repair. The procedure is not described by another anesthesia code and is performed in the outpatient hospital setting.
Coding Specifications
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Modifiers:
Modifier Code Description Usage Context QSMonitored anesthesia care service Used when anesthesia is provided as monitored anesthesia care (MAC) rather than general anesthesia. QXCRNA service with medical direction by a physician Used when a CRNA provides anesthesia services under the medical direction of a physician. -
Provider Taxonomies:
Taxonomy Code Specialty 207L00000XAnesthesiology 367500000XCertified Registered Nurse Anesthetist 207LA0401XPain Medicine (Anesthesiology)
These taxonomies represent providers qualified to deliver anesthesia services for shoulder cast procedures.
Related Diagnoses
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M17.11- Unilateral primary osteoarthritis, right knee- Relevant when a patient has osteoarthritis affecting the right knee, which may contribute to mobility issues or pain requiring immobilization or anesthesia for related procedures.
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M17.12- Unilateral primary osteoarthritis, left knee- Indicates osteoarthritis in the left knee, potentially associated with musculoskeletal conditions requiring anesthesia for procedures.
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S83.511A- Sprain of anterior cruciate ligament of right knee, initial encounter- Represents an acute knee injury; while not directly related to the shoulder, it may be coded if the patient has multiple injuries requiring anesthesia.
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S83.512A- Sprain of anterior cruciate ligament of left knee, initial encounter- Similar to above, for the left knee; may be relevant in multi-injury scenarios.
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M25.561- Pain in right knee- Indicates pain in the right knee, which may be part of the patient's overall clinical picture.
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M25.562- Pain in left knee- Indicates pain in the left knee; relevant for documentation if the patient has multiple sites of pain.
These diagnoses are associated with musculoskeletal conditions and injuries that may necessitate anesthesia services for procedures such as cast application, removal, or repair, especially in complex cases or when multiple injuries are present.
Related CPT Codes
01670- Anesthesia for Procedures on the Shoulder and Axilla (any procedure on the veins of the shoulder and axilla)
01670 is related to 01680 as both codes pertain to anesthesia services for procedures involving the shoulder and axilla. While 01680 is specific to shoulder cast application, removal, or repair, 01670 covers anesthesia for procedures on the veins of the shoulder and axilla. These codes may be used as alternatives depending on the specific procedure performed. They are not typically used together, as each describes anesthesia for distinct procedural types.
National Reimbursement Benchmarks
National mean rates for CPT code 01680 show that commercial payers generally reimburse at higher levels than Medicare. The BUCA (average commercial) mean rate is $102.89, while UnitedHealth Group (UHC) has the lowest mean rate among the major commercial payers at $65.54. Blue Cross Blue Shield and Cigna have the highest mean rates, at $186.69 and $198.47 respectively.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. UnitedHealth Group has the tightest range ($25.08), indicating less variability in rates, while Cigna and Blue Cross Blue Shield show much wider ranges ($172.33 and $137.60, respectively), reflecting greater variability in contracted rates. Aetna also exhibits a wide range ($168.00), suggesting substantial rate differences across providers.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska displays a wide rate spread for CPT code 01680, particularly with Blue Cross Blue Shield, where the difference between the 75th and 25th percentiles is $91.47. This indicates substantial variability in reimbursement rates among providers. In contrast, Aetna and UnitedHealth Group show minimal spread, with all percentiles clustered closely around $72, suggesting consistent rates across providers.
Compared to national averages, Blue Cross Blue Shield's mean rate in Alaska is notably higher, while Cigna and UnitedHealth Group are below their respective national means. The table and chart below present the full breakdown of payer-specific rates for Alaska, highlighting these differences and the overall distribution.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 01680 in Alaska, with a mean rate of $219.21.
- UnitedHealth Group offers the lowest mean rate at $74.78.
- Blue Cross Blue Shield's mean rate in Alaska is significantly higher than its national average, while Cigna and UnitedHealth Group are below their respective national means.
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.