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 |
| 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
| 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 | $86.00 | 1124447115 - CHRISTINA NGUYEN | 954377219 | 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 | $70.00 | 1326278334 - SHEILA RAJASHEKARA | 260089066 | CA | Pediatric Anesthesiology Physician (207LP3000X) |
United | 01638 | $99.00 | 1669738175 - THEODORA WINGERT | 954377219 | CA | Anesthesiology Physician (207L00000X) |
United | 01638 | $38.00 | 1639184344 - INTEGRATED PAIN SPECIALISTS OF SOUTHERN CALIFORNIA, INC., KEVIN S. SMITH, M.D. | 205023370 - (CA) INTEGRATED PAIN SPECIALISTS OF SOUTHERN CALIFORNIA | CA | Pain Medicine (Anesthesiology) Physician (207LP2900X) |
United | 01638 | $71.19 | 1174580955 - MICHAEL LEW | 274803222 - CITY OF HOPE MEDICAL FOUNDATION | CA | Anesthesiology Physician (207L00000X) |
United | 01638 | $71.00 | 1386771707 - DAVID MOROMISATO | 901116750 - (AZ) BANNER | CA | Critical Care Medicine (Anesthesiology) Physician (207LC0200X) |
United | 01638 | $58.00 | 1790996825 - EDNA MA | 464316329 | CA | Anesthesiology Physician (207L00000X) |
United | 01638 | $60.00 | 1790168722 - LEE NGUYEN | 680334324 | CA | Anesthesiology Physician (207L00000X) |
United | 01638 | $65.00 | 1891968608 - PETER SCHMIDT | 770465765 | CA | Pain Medicine (Anesthesiology) Physician (207LP2900X) |
United | 01638 | $70.00 | 1003872946 - ISOBEL RUSSELL | 260089066 | CA | Anesthesiology Physician (207L00000X) |
United | 01638 | $49.31 | 1619950524 - ALAMELU NAGAPPAN | 330587303 - (CA) RIVERSIDE MEDICAL CLINIC, INC. | CA | Anesthesiology Physician (207L00000X) |
United | 01638 | $57.20 | 1134268881 - MATTHEW BARRY | 941502014 - SOUTHERN MONTEREY COUNTY MEMORIAL HOSPITAL | CA | Anesthesiology Physician (207L00000X) |
United | 01638 | $56.00 | 1750434783 - OJI OJI | 882872979 - (CA) VALLEY REGIONAL ANESTHESIA ASSOCIATES INC | CA | Anesthesiology Physician (207L00000X) |
United | 01638 | $78.00 | 1982846325 - JASPER ROSARIO | 954656412 - (CA) PACIFIC VALLEY MEDICAL GROUP | CA | Anesthesiology Physician (207L00000X) |
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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