Summary & Overview
CPT 01130: Anesthesia for Body Cast Procedure
Headline: Anesthesia for Body Cast Procedures Draws Attention for Specialized Perioperative Care
Lead: CPT 01130 denotes anesthesia services provided during body cast procedures such as applying or revising a body cast. The code captures perioperative anesthetic management for procedures that immobilize large body segments, typically billed by anesthesiology providers in hospital or ambulatory surgical settings.
What the code represents and why it matters: CPT 01130 identifies a focused anesthesiology service tied to body cast application or revision. Nationally, accurate coding of this service affects care coordination, resource planning, and payment processes for procedures that may require specialized airway, positioning, or monitoring considerations.
Key payers covered: This overview addresses payer approaches from Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
What readers will learn: The publication outlines coding context, common clinical indications, billing patterns, and payer coverage considerations for CPT 01130. It summarizes benchmarks for typical sites of service and clarifies where data is not provided. The piece highlights associated clinical scenarios, common ICD-10 diagnoses seen with these procedures, and related anesthesia service codes for reference.
Scope and limitations: Service line metadata is not provided in the input. Data not available in the input is noted where applicable. The content is intended for a national audience and does not reference specific state policy.
CPT Code Overview
CPT 01130 describes anesthesia services provided for body cast procedures, such as applying or revising a body cast. This code is used for anesthesiology care during procedures that require immobilization of the torso or large body segments with a cast.
Service type: Anesthesiology
Typical site of service: Physician billing to Carrier (typically hospital or surgical center)
Clinical & Coding Specifications
Clinical Context
A middle-aged patient presents to the hospital operating room or surgical center for application or revision of a body cast to immobilize the thorax, spine, or pelvis after traumatic injury or to manage postoperative spinal stabilization. Typical presenting problems include acute low back pain after trauma, fractures involving the lumbar spine or pelvis, or care following spinal surgery with persistent symptoms. The patient is evaluated preoperatively by the anesthesia team, including an anesthesiologist or Certified Registered Nurse Anesthetist (CRNA). Standard pre-anesthesia assessment, airway evaluation, and review of comorbidities are completed. Monitored anesthesia care (MAC) or general anesthesia may be provided depending on patient status, extent of the casting procedure, and surgeon preference. Intraoperative physiologic monitoring is performed, and post-anesthesia recovery includes pain control and monitoring for neurovascular compromise of the immobilized areas. Documentation in the anesthesia record includes indication, anesthetic technique, medications, monitoring, and any complications.
Coding Specifications
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Modifiers
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QS: Monitored anesthesia care service — use when the anesthesia provided is MAC for the body cast procedure. -
QX: CRNA service with medical direction by a physician — use when a Certified Registered Nurse Anesthetist furnishes the anesthesia under medical direction as defined by payer rules. -
Provider Taxonomies
| Taxonomy Code | Specialty |
|---|---|
207L00000X | Anesthesiology — physician specialists providing anesthesia care |
367500000X | Certified Registered Nurse Anesthetist — advanced practice nurses delivering anesthesia services |
207LC0200X | Critical Care Medicine (Anesthesiology) — anesthesiologists with critical care specialization |
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Notes
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Use the modifier
QSwhen billing monitored anesthesia care consistent with payer definitions. -
Use the modifier
QXwhen a CRNA performs the service with physician medical direction and payer policy requires identification of that arrangement. -
When no specific instructions are available for other modifiers or components, follow individual payer billing rules.
Related Diagnoses
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S32.9XXA— Fracture of unspecified part of lumbar spine and pelvis, initial encounterClinical relevance: Fractures of the lumbar spine or pelvis commonly require immobilization with a body cast or casting procedure, indicating the need for anesthesia services coded with
01130. -
M84.48XA— Pathological fracture, other site, initial encounterClinical relevance: Pathological fractures at non-specific sites may necessitate application or revision of a body cast to stabilize the area; anesthesia for that casting is reported with
01130when appropriate. -
M96.1— Postlaminectomy syndrome, not elsewhere classifiedClinical relevance: Patients with postlaminectomy pain or complications may require procedures that include casting or immobilization of the spine; anesthesia for such body cast procedures can be reported with
01130. -
M47.819— Spondylosis without myelopathy or radiculopathy, site unspecifiedClinical relevance: Degenerative spine conditions like spondylosis can lead to instability or pain managed with immobilization; application or revision of a body cast in this context may require anesthesia services coded with
01130. -
M54.5— Low back painClinical relevance: Acute or chronic low back pain related to injury or degenerative disease may be an indication for casting or immobilization procedures where anesthesia is provided and reported with
01130.
Related CPT Codes
| CPT Code | Description |
|---|---|
00100 | Anesthesia for procedures on salivary glands, including biopsy — An anesthesia code for a different anatomical area; listed as a related code for cross-reference. |
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Relationship to primary code
01130: -
00100represents an anesthesia service for procedures on the salivary glands and is unrelated anatomically; it is provided here as a related CPT cross-reference. It may be used as an alternative anesthesia code when the procedure performed involves salivary gland surgery rather than body casting. Codes are not typically billed together for the same encounter; they serve as separate anesthesia service codes for distinct procedures.
National Reimbursement Benchmarks
National commercial mean rates exceed Medicare substantially when comparing BUCA (average commercial) with Medicare. BUCA’s mean allowed rate of $105.89 is higher than Medicare’s reported value of $0.00 in the input, indicating Medicare values are not provided in the dataset for direct numeric comparison.
Rate dispersion (P75 minus P25) varies across payers. Cigna shows one of the widest dispersions (262.00 - 89.00 = $173.00), followed by BCBS (233.00 - 128.00 = $105.00) and Aetna (212.00 - 40.00 = $172.00). UnitedHealth Group has the tightest dispersion (75.25 - 50.33 = $24.92). The table and chart below present the full breakdown.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska demonstrates a significant rate spread for CPT code 01130, particularly with Blue Cross Blue Shield, where the difference between the 75th and 25th percentiles is $91.47. This indicates substantial variability in reimbursement rates across payers. In contrast, Aetna and UnitedHealth Group show minimal spread, with all percentiles clustered closely around $72.00, suggesting more uniform rates.
Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are notably higher, while Cigna and UnitedHealth Group are closer to or slightly above national benchmarks. The table and chart below present the full breakdown of payer-specific rates for Alaska.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 01130 in Alaska, with a mean rate of $219.12.
- UnitedHealth Group offers the lowest mean rate at $75.12.
- Alaska's mean rates for most payers are higher than national averages, especially for Blue Cross Blue Shield and BUCA.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.