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See a sample rate comparisonCPT 01638 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Anesth Shoulder Replacement, Anesthesia For Open Or Surgical Arthroscopic Procedures On Humeral Head And Neck Sternoclavicular Joint Acromioclavicular Joint And Shoulder Joint Total Shoulder Replacement
| Key Fact | Detail |
|---|---|
| Service Type | Anesthesia Anesthesia for Procedures on the Shoulder and Axilla |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None P3 - A patient with severe systemic disease AA - Anesthesia by anesthesiologist |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 01638 |
National average anesthesia conversion factor for CPT 01638 by major payers:
$58.03
$104.24
$56.89
$55.24
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CPT 01638
5 of 25 sample ratesHigher to lower in this preview
Gerald Dubowitz
$128.69Published rateJasper Rosario
Pacific Valley Medical Group
$78.00Published ratePeter Schmidt
$65.00Published rateLee Nguyen
$60.00Published rateIntegrated Pain Specialists Of Southern California, Inc., Kevin S. Smith, M.D.
Integrated Pain Specialists Of Southern California
$38.00Published rate
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See a sample payer proposalCPT 01638 vs. Other Anesthesia for Procedures on the Shoulder and Axilla Codes
The CPT 01638 code is part of the Anesthesia services used for Anesthesia for Procedures on the Shoulder and Axilla. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 01638 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 01620-CPT | Low | Anesthesia For Joint Procedure, Anesthesia Services For A Noninvasive Procedure Involving A Joint Such As A Scope-Assisted Exam. Common Exam Sites Include Hip Knee Shoulder Wrist Ankle And Elbow. |
| 01622-CPT | Low | Anesthesia For Joint Procedure, Anesthesia Services For A Noninvasive Procedure Involving A Joint Such As A Scope-Assisted Exam. Common Exam Sites Include Hip Knee Shoulder Wrist Ankle And Elbow. |
| 01630-CPT | Moderate | Anesthesia For Joint Surgery, Anesthesia Services For A Surgery Involving A Joint Such As A Scope-Assisted Exam Repair Of A Broken Bone Or Removal Of A Bone. Joint Surgery May Involve The Hip Knee Shoulder Elbow Wrist Or Neck. |
| 01638-CPT | Moderate | Anesth Shoulder Replacement, Anesthesia For Open Or Surgical Arthroscopic Procedures On Humeral Head And Neck Sternoclavicular Joint Acromioclavicular Joint And Shoulder Joint Total Shoulder Replacement |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 01638. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 01638 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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