Summary & Overview
CPT 01200: Anesthesia for Upper Leg Procedures (Except Knee)
CPT code 01200 covers anesthesia for procedures performed on the upper leg, excluding the knee, and is a critical component in surgical care across a variety of clinical settings. This code is widely recognized and utilized by anesthesiology professionals to ensure patient safety and comfort during upper leg surgeries. Nationally, the code is accepted by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, reflecting its broad applicability and importance in medical billing and reimbursement.
Readers will gain insight into the clinical context of 01200, including its role in supporting surgical interventions on the upper leg. The publication provides an overview of payer coverage, common modifiers, and associated taxonomies, as well as relevant ICD-10 diagnoses that frequently accompany these procedures. Additionally, related CPT codes are highlighted to illustrate the range of anesthesia services for upper leg procedures. The summary offers benchmarks and policy updates relevant to anesthesiology billing, helping stakeholders understand the evolving landscape of anesthesia reimbursement and coding practices. This information is essential for healthcare administrators, billing professionals, and clinicians seeking to stay informed about anesthesia coding standards and payer requirements.
CPT Code Overview
CPT code 01200 is designated for anesthesia services provided during procedures on the upper leg, excluding the knee. This code falls under the anesthesiology service type, which encompasses the administration and management of anesthesia to ensure patient comfort and safety during surgical interventions. The typical site of service for this code is unknown based on available data. This code is utilized by healthcare professionals specializing in anesthesiology to support a range of upper leg procedures, ensuring appropriate sedation and pain control throughout the operative process.
Clinical & Coding Specifications
Clinical Context
A patient presents for a surgical procedure involving the upper leg, excluding the knee. The clinical workflow typically involves preoperative assessment by an anesthesiologist, followed by administration of anesthesia for the procedure. The patient may have conditions such as muscle, tendon, or nerve injuries, or require arthroscopic intervention. The anesthesia is provided by a specialist in anesthesiology, pain medicine, or pediatric anesthesiology, depending on patient age and complexity. The procedure is performed in a hospital or ambulatory surgical center, with monitoring throughout the perioperative period.
Coding Specifications
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Modifiers:
QS: Monitored anesthesia care service. Used when the anesthesiologist provides monitored anesthesia care rather than general anesthesia.P1: A normal healthy patient. Indicates the patient has no systemic disease and is classified as ASA Physical Status 1.
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207L00000X | Anesthesiology |
207LA0401X | Pain Medicine (Anesthesiology) |
207LP2900X | Pediatric Anesthesiology |
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Specialties Represented:
- Anesthesiology: General anesthesia services.
- Pain Medicine (Anesthesiology): Focused on pain management during procedures.
- Pediatric Anesthesiology: Specialized care for pediatric patients undergoing anesthesia.
Related Diagnoses
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M75.100: Unspecified rotator cuff tear or rupture of unspecified shoulder- Relevant for patients with shoulder injuries requiring surgical intervention, potentially involving upper leg procedures if part of a multi-site operation.
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S43.401A: Sprain of unspecified acromioclavicular joint, initial encounter- Indicates acute shoulder injury; may be associated with trauma cases where multiple sites are addressed.
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M19.011: Primary osteoarthritis, right shoulder- Represents degenerative joint disease; relevant if the patient has comorbidities affecting surgical planning.
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M19.012: Primary osteoarthritis, left shoulder- Similar to
M19.011, but affecting the left shoulder.
- Similar to
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S42.001A: Fracture of unspecified part of right clavicle, initial encounter- Indicates acute fracture; may be relevant in trauma cases requiring anesthesia for upper leg procedures as part of comprehensive care.
Related CPT Codes
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01202: Under Anesthesia for Procedures on the Upper Leg (Except Knee) – arthroscopic procedure of the hip joint.- Used when the procedure involves arthroscopy of the hip joint, requiring anesthesia services similar to
01200.
- Used when the procedure involves arthroscopy of the hip joint, requiring anesthesia services similar to
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01250: Under Anesthesia for Procedures on the Upper Leg (Except Knee) – procedure on nerves, muscles, tendons, fascia, and bursae of the upper leg.- Used for procedures targeting nerves, muscles, tendons, fascia, or bursae in the upper leg, which may require anesthesia services.
Clinical Relationship:
01202and01250are related to01200as they all involve anesthesia for upper leg procedures, excluding the knee.- These codes may be used as alternatives depending on the specific surgical intervention performed.
- It is uncommon to use these codes together for a single procedure; typically, one is selected based on the operative site and technique.
National Reimbursement Benchmarks
National mean rates for CPT code 01200 show that Blue Cross Blue Shield and Cigna have the highest average reimbursement, at $223.37 and $248.08 respectively, while UnitedHealth Group is notably lower at $65.66. The BUCA (average commercial) mean rate stands at $130.75, which is significantly higher than UnitedHealth Group but well below Cigna and Blue Cross Blue Shield. Medicare rates are not available in the input.
Rate dispersion varies considerably across payers. Cigna exhibits the widest spread, with a difference of $259.00 between its 75th and 25th percentiles, indicating substantial variability in reimbursement. In contrast, UnitedHealth Group has the tightest range, with only $25.67 separating its 75th and 25th percentiles, suggesting more consistent rates. Blue Cross Blue Shield and Aetna also show notable dispersion, but less than Cigna.
The table and chart below present a detailed breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska demonstrates a wide spread in reimbursement rates for CPT code 01200, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($298.50 minus $225.80 = $72.70), while Aetna and UnitedHealth Group have minimal spread ($72.00 to $72.00 and $72.00 to $76.00, respectively). This indicates that some payers in Alaska have tightly clustered rates, while others, like Blue Cross Blue Shield and BUCA, offer broader variability.
Compared to national averages, Alaska's mean rates for most payers are higher, particularly for Blue Cross Blue Shield and Aetna. However, Cigna and UnitedHealth Group in Alaska pay less than their national mean rates. The table and chart below present the full breakdown of payer-specific rates in Alaska.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer in Alaska for CPT 01200, with a mean rate of $267.04.
- UnitedHealth Group offers the lowest mean rate at $75.12, significantly below both state and national averages.
- Alaska's mean rates for most payers are notably higher than national benchmarks, except for Cigna and UnitedHealth Group, which are lower.
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