How much does Medicare pay for CPT 01638?

Medicare allowed an average of $252.83 per service and paid $200.03 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2863.12, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 01638?

Anesthesia for open or endoscopic total shoulder joint replacement. It was billed 25,726 times to 25,531 Medicare beneficiaries by 1,554 providers in 2024.

Does 01638 pay differently in an office than a hospital?

Yes. The allowed amount averaged $270.34 in an office setting and $252.76 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 01638 most?

Anesthesiology, with 15,985 services from 942 clinicians. Next are Certified Registered Nurse Anesthetist (CRNA), Anesthesiology Assistant, Pain Management.

CPT 01638

Anesthesia for open or endoscopic total shoulder joint replacement

$252.83Medicare-allowed amount per service, averaged across 25,726 services

Providers submitted

$2863.12

Asking price, not received

Medicare allowed

$252.83

The fee schedule figure

Medicare paid

$200.03

Balance is patient coinsurance

Providers submitted an average of $2863.12 for this code and Medicare allowed $252.83 — 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 $200.03 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $270.34
Hospital / facility: $252.76

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. 92 services were billed in an office setting and 25,634 in a facility.

Services: 25,726
Beneficiaries: 25,531
Providers billing it: 1,554
Total allowed: $6,504,305

What Medicare pays for CPT 01638

Across 25,726 services billed by 1,554 providers to 25,531 beneficiaries, Medicare allowed an average of $252.83 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 01638

Specialty	Services	Beneficiaries	Avg allowed	Providers
Anesthesiology	15,985	15,855	$244.07	942
Certified Registered Nurse Anesthetist (CRNA)	9,201	9,141	$270.00	580
Anesthesiology Assistant	320	318	$202.18	24
Pain Management	132	129	$231.36	4
Internal Medicine	47	47	$279.80	1
Interventional Pain Management	22	22	$312.26	2
Critical Care (Intensivists)	19	19	$168.52	1

01638 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	2,191	$261.34	$200.53	119
Texas	1,799	$244.69	$194.09	93
Pennsylvania	1,579	$217.15	$169.88	102
Ohio	1,457	$226.46	$179.94	94
North Carolina	1,297	$190.45	$155.28	76
New York	1,175	$332.35	$241.02	68
California	1,153	$378.70	$288.15	71
Virginia	1,152	$221.81	$176.10	68
Massachusetts	1,076	$231.71	$177.02	60
Tennessee	939	$201.94	$164.77	51
Illinois	931	$258.47	$195.65	55
South Carolina	819	$206.11	$167.42	52
Michigan	651	$211.57	$164.49	42
Colorado	600	$264.07	$208.58	36
New Jersey	579	$266.60	$196.95	35
Minnesota	570	$210.96	$168.63	36
Indiana	563	$241.99	$200.97	33
Arizona	556	$317.81	$251.42	38
Kentucky	551	$228.24	$185.53	33
Missouri	531	$238.48	$195.56	31
Maryland	523	$256.18	$193.33	32
Georgia	418	$251.04	$201.84	30
Washington	410	$344.21	$273.78	25
Connecticut	406	$254.70	$193.86	27
Kansas	388	$251.28	$208.65	25
South Dakota	322	$191.74	$159.98	23
Louisiana	304	$244.94	$199.28	19
Iowa	284	$258.23	$212.24	19
Oklahoma	278	$319.15	$262.33	20
Nebraska	238	$284.47	$238.42	17
Utah	231	$360.14	$283.29	10
Alabama	185	$184.32	$154.89	12
Nevada	152	$329.49	$262.47	9
Arkansas	144	$323.99	$274.45	9
Delaware	143	$248.91	$199.80	8
Mississippi	138	$188.47	$158.34	10
Oregon	138	$336.15	$264.19	8
Wisconsin	125	$261.53	$213.44	10
North Dakota	112	$172.25	$139.92	7
New Hampshire	100	$294.69	$238.32	7
West Virginia	85	$207.39	$163.41	5
Wyoming	76	$326.58	$265.55	5
Alaska	76	$437.23	$266.75	5
Maine	70	$269.66	$214.77	4
Idaho	64	$333.16	$272.36	5
District of Columbia	52	$193.80	$144.95	3
Rhode Island	31	$223.98	$175.62	2
Montana	24	$377.87	$295.60	2
Vermont	17	$236.79	$178.39	1
New Mexico	12	$331.35	$266.19	1
Hawaii	11	$366.86	$291.91	1

Related codes

01630Anesthesia for other procedure on top of arm bone and shoulder joint$161.15
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.