How much does Medicare pay for CPT 01610?

Medicare allowed an average of $167.35 per service and paid $132.15 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2088.00, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 01610?

Anesthesia for procedure on nerves, muscles, tendons, fascia, and bursae of shoulder and underarm. It was billed 3,530 times to 3,502 Medicare beneficiaries by 222 providers in 2024.

Does 01610 pay differently in an office than a hospital?

Yes. The allowed amount averaged $137.55 in an office setting and $175.56 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 01610 most?

Anesthesiology, with 2,186 services from 138 clinicians. Next are Certified Registered Nurse Anesthetist (CRNA), Pain Management, Anesthesiology Assistant.

CPT 01610

Anesthesia for procedure on nerves, muscles, tendons, fascia, and bursae of shoulder and underarm

$167.35Medicare-allowed amount per service, averaged across 3,530 services

Providers submitted

$2088.00

Asking price, not received

Medicare allowed

$167.35

The fee schedule figure

Medicare paid

$132.15

Balance is patient coinsurance

Providers submitted an average of $2088.00 for this code and Medicare allowed $167.35 — 12.5× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $132.15 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $137.55
Hospital / facility: $175.56

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 762 services were billed in an office setting and 2,768 in a facility.

Services: 3,530
Beneficiaries: 3,502
Providers billing it: 222
Total allowed: $590,746

What Medicare pays for CPT 01610

Across 3,530 services billed by 222 providers to 3,502 beneficiaries, Medicare allowed an average of $167.35 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 01610

Specialty	Services	Beneficiaries	Avg allowed	Providers
Anesthesiology	2,186	2,180	$164.66	138
Certified Registered Nurse Anesthetist (CRNA)	1,237	1,215	$174.08	76
Pain Management	53	53	$133.00	4
Anesthesiology Assistant	40	40	$141.98	3
Family Practice	14	14	$195.35	1

01610 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	552	$162.36	$121.59	35
New York	533	$167.80	$120.18	31
Texas	352	$185.73	$147.16	21
North Carolina	191	$145.87	$119.07	13
Kansas	170	$133.34	$107.42	9
Arizona	158	$162.30	$126.70	9
Virginia	140	$148.87	$115.43	7
New Jersey	138	$113.72	$85.93	8
Massachusetts	118	$153.41	$111.21	9
Pennsylvania	114	$136.67	$106.72	8
South Carolina	102	$174.14	$140.37	7
Michigan	102	$146.34	$115.30	5
California	97	$268.38	$205.07	8
Maryland	93	$266.54	$204.07	6
Georgia	77	$156.70	$124.24	5
Arkansas	67	$208.22	$176.53	5
Ohio	58	$206.63	$167.28	4
Oklahoma	52	$228.50	$186.16	4
Tennessee	51	$142.48	$115.60	3
Illinois	49	$156.91	$119.78	3
Wisconsin	38	$140.13	$113.95	3
Louisiana	36	$191.81	$156.11	3
Nebraska	33	$188.32	$157.82	2
Indiana	30	$164.48	$131.43	2
Kentucky	24	$111.30	$89.56	2
Oregon	23	$130.25	$100.52	1
New Hampshire	22	$137.38	$107.49	1
Missouri	18	$127.75	$92.30	1
Utah	18	$264.32	$209.03	1
District of Columbia	14	$158.01	$121.37	1
Alaska	13	$199.12	$101.07	1
Mississippi	12	$131.78	$83.79	1
Minnesota	12	$183.48	$152.38	1
South Dakota	12	$175.28	$145.41	1
Delaware	11	$160.62	$130.29	1

Related codes

01630Anesthesia for other procedure on top of arm bone and shoulder joint$161.15
01638Anesthesia for open or endoscopic total shoulder joint replacement$252.83

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.