CPT 01638 Fee Schedule
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.
| 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 |
National average anesthesia conversion factor for CPT 01638 by major payers:
$58.03
$104.24
$56.89
$55.24
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 01638 | ||||||
United | 01638 | $113.00 | 1508108085 - GORDON CHEN | 680273974 - SUTTER VALLEY MEDICAL FOUNDATION | CA | Anesthesiology Physician (207L00000X) |
United | 01638 | $35.00 | 1417376435 - FRANCESCA BETTI | 954457756 - (CA) CEDARS-SINAI MEDICAL CARE FOUNDATION | CA | Anesthesiology Physician (207L00000X) |
United | 01638 | $77.18 | 1629130455 - SHELDON STOHL | 953777340 - CHILDRENS HOSPITAL LOS ANGELES MEDICAL GROUP INC | CA | Anesthesiology Physician (207L00000X) |
United | 01638 | $71.19 | 1174580955 - MICHAEL LEW | 274803222 - CITY OF HOPE MEDICAL FOUNDATION | CA | Anesthesiology Physician (207L00000X) |
United | 01638 | $62.00 | 1235199373 - RONALD BOTELHO | 680238424 - (CA) ANESTHESIA & ANALGESIA MEDICAL GROUP, INC. | CA | Pain Medicine (Anesthesiology) Physician (207LP2900X) |
United | 01638 | $99.00 | 1134756596 - RYAN NGUYEN | 954395492 | CA | Anesthesiology Physician (207L00000X) |
United | 01638 | $35.00 | 1073972337 - ALEA MORRISON | 954457756 - (CA) CEDARS-SINAI MEDICAL CARE FOUNDATION | CA | Anesthesiology Physician (207L00000X) |
United | 01638 | $52.00 | 1629501945 - MANSHU YAN | 463842055 - (CA) HP ANESTHESIA INC | CA | Critical Care Medicine (Anesthesiology) Physician (207LC0200X) |
United | 01638 | $54.00 | 1518385343 - PAUL CHENG | 943168453 | CA | Pain Medicine (Anesthesiology) Physician (207LP2900X) |
United | 01638 | $52.50 | 1417394784 - HEIDI HASKINS | 953777340 - CHILDRENS HOSPITAL LOS ANGELES MEDICAL GROUP INC | CA | Pain Medicine (Anesthesiology) Physician (207LP2900X) |
United | 01638 | $44.00 | 1295000438 - ALESSA MEDICAL CORPORATION | 452770244 - (CA) ALESSA MEDICAL CORPORATION | CA | Anesthesiology Physician (207L00000X) |
United | 01638 | $60.00 | 1912061805 - SCOTT PRITZLAFF | 680344702 | CA | Anesthesiology Physician (207L00000X) |
United | 01638 | $117.22 | 1649350703 - CHRISTINE HOLLISTER | 952226406 - REGENTS OF THE UNIVERSITY OF CALIFORNIA AT IRVINE | CA | Anesthesiology Physician (207L00000X) |
United | 01638 | $57.50 | 1588738421 - DOROTHEA HALL | 954395492 | CA | Anesthesiology Physician (207L00000X) |
United | 01638 | $73.83 | 1669835237 - ELIZABETH FEENSTRA | 582030692 - EMORY UNIVERSITY | CA | Pain Medicine (Anesthesiology) Physician (207LP2900X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 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 All Closed Procedures On Humeral Head And Neck, Sternoclavicular Joint, Acromioclavicular Joint, And Shoulder Joint |
| 01622-CPT | Low | Anes Shoulder Joint Arthroscopy |
| 01630-CPT | Moderate | Anesthesia For Open Or Surgical Arthroscopic Procedures On Humeral Head And Neck, Sternoclavicular Joint, Acromioclavicular Joint, And Shoulder Joint; Not Otherwise Specified |
| 01638-CPT | Moderate | 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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