How much does Medicare pay for CPT 01630?

Medicare allowed an average of $161.15 per service and paid $126.69 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1825.15, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 01630?

Anesthesia for other procedure on top of arm bone and shoulder joint. It was billed 28,603 times to 28,449 Medicare beneficiaries by 1,618 providers in 2024.

Does 01630 pay differently in an office than a hospital?

Yes. The allowed amount averaged $161.54 in an office setting and $161.14 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 01630 most?

Anesthesiology, with 18,101 services from 963 clinicians. Next are Certified Registered Nurse Anesthetist (CRNA), Anesthesiology Assistant, Pain Management.

CPT 01630

Anesthesia for other procedure on top of arm bone and shoulder joint

$161.15Medicare-allowed amount per service, averaged across 28,603 services

Providers submitted

$1825.15

Asking price, not received

Medicare allowed

$161.15

The fee schedule figure

Medicare paid

$126.69

Balance is patient coinsurance

Providers submitted an average of $1825.15 for this code and Medicare allowed $161.15 — 11.3× 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 $126.69 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $161.54
Hospital / facility: $161.14

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 379 services were billed in an office setting and 28,224 in a facility.

Services: 28,603
Beneficiaries: 28,449
Providers billing it: 1,618
Total allowed: $4,609,373

What Medicare pays for CPT 01630

Across 28,603 services billed by 1,618 providers to 28,449 beneficiaries, Medicare allowed an average of $161.15 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 01630

Specialty	Services	Beneficiaries	Avg allowed	Providers
Anesthesiology	18,101	17,983	$159.43	963
Certified Registered Nurse Anesthetist (CRNA)	9,789	9,755	$167.46	607
Anesthesiology Assistant	599	597	$114.44	40
Pain Management	67	67	$150.88	4
Internal Medicine	13	13	$124.65	1
Interventional Pain Management	12	12	$119.70	1
Critical Care (Intensivists)	11	11	$103.74	1
Emergency Medicine	11	11	$116.02	1

01630 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	2,398	$159.81	$121.97	128
Texas	2,304	$173.81	$137.95	136
North Carolina	1,826	$122.52	$99.47	88
California	1,717	$251.05	$191.78	93
Pennsylvania	1,321	$137.89	$107.86	83
Virginia	1,306	$133.98	$106.48	75
New York	1,239	$155.55	$113.75	72
Massachusetts	1,188	$152.22	$115.03	62
Tennessee	981	$145.67	$119.77	60
South Carolina	976	$128.81	$102.81	51
Georgia	943	$127.97	$101.39	58
Ohio	854	$128.34	$102.23	52
Mississippi	787	$135.77	$112.68	41
Michigan	774	$117.82	$91.19	39
Alabama	766	$115.76	$96.27	43
Missouri	669	$159.30	$128.63	39
Arizona	650	$218.62	$174.50	41
Illinois	630	$184.38	$138.45	39
Arkansas	561	$166.32	$138.47	28
Washington	529	$216.38	$173.11	32
New Jersey	523	$184.98	$137.16	31
Oklahoma	495	$208.15	$167.32	33
Maryland	475	$205.68	$157.51	29
Colorado	457	$161.25	$126.26	19
Kansas	424	$140.43	$116.03	22
Indiana	386	$178.42	$147.64	23
Louisiana	332	$161.76	$132.51	19
Oregon	268	$203.09	$161.27	13
Connecticut	263	$151.64	$116.18	17
Utah	257	$183.75	$149.79	11
Kentucky	251	$165.81	$132.89	16
West Virginia	178	$119.61	$96.20	10
Wisconsin	169	$153.46	$123.87	12
Nevada	161	$195.91	$154.17	11
North Dakota	156	$122.10	$99.01	8
District of Columbia	148	$139.28	$105.23	10
Minnesota	141	$182.30	$146.65	7
New Hampshire	137	$184.04	$150.48	10
South Dakota	132	$116.37	$95.64	10
Nebraska	119	$209.07	$173.92	8
Delaware	117	$135.82	$108.22	6
Hawaii	111	$209.13	$171.21	2
Montana	104	$226.91	$173.03	8
Maine	79	$160.49	$127.95	4
Iowa	77	$182.08	$148.65	5
Idaho	62	$215.24	$180.81	4
New Mexico	51	$219.04	$173.78	2
Rhode Island	43	$164.89	$123.91	3
Wyoming	29	$254.00	$194.60	2
Alaska	27	$144.05	$120.24	2
Puerto Rico	12	$300.64	$224.46	1

Related codes

01638Anesthesia for open or endoscopic total shoulder joint replacement$252.83
01610Anesthesia for procedure on nerves$167.35

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.