Summary & Overview
CPT 01212: Anesthesia for Open Hip Joint Procedures, Hip Disarticulation
CPT code 01212 represents anesthesia for open procedures involving the hip joint, specifically hip disarticulation. This code is nationally relevant due to the complexity and critical nature of hip disarticulation surgeries, which require specialized anesthesia care in hospital or surgical center operating rooms. The publication covers key payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, providing a comprehensive overview of payer coverage and policy considerations for this high-acuity service.
Readers will gain insight into the clinical context of hip disarticulation anesthesia, typical sites of service, and the importance of accurate coding for reimbursement and compliance. The summary includes benchmarks, policy updates, and related clinical information, helping stakeholders understand how this code fits within broader anesthesia billing practices. The publication also highlights common modifiers and associated provider taxonomies, offering a clear view of the coding landscape for anesthesia services in orthopedic surgery. This information is essential for healthcare professionals, billing specialists, and policy analysts seeking to stay informed about anesthesia coding and payer requirements for complex hip procedures.
CPT Code Overview
CPT code 01212 is used to report anesthesia services for open procedures involving the hip joint, specifically hip disarticulation. This code applies to cases where a patient undergoes surgical removal of the entire hip joint, typically performed in an operating room setting within an inpatient hospital or surgical center. The service type is anesthesia, and it is provided to ensure patient comfort and safety during complex orthopedic surgeries involving the hip. This procedure is significant due to its complexity and the critical role of anesthesia in facilitating successful surgical outcomes.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult undergoing an open surgical procedure for hip disarticulation, often due to severe joint disease, trauma, or malignancy. The patient is admitted to an inpatient hospital or surgical center and requires comprehensive anesthesia care throughout the operation. The clinical workflow includes preoperative assessment by an anesthesiologist or certified registered nurse anesthetist, administration of anesthesia in the operating room, continuous monitoring during the procedure, and postoperative recovery management.
Coding Specifications
-
Modifiers:
QS: Monitored anesthesia care service. Used when the anesthesia provider delivers monitored anesthesia care rather than general anesthesia.QX: CRNA service with medical direction by a physician. Applied when a certified registered nurse anesthetist provides anesthesia under the medical direction of a physician.
-
Provider Taxonomies:
207L00000X: Anesthesiology – represents physicians specializing in anesthesia.367500000X: Certified Registered Nurse Anesthetist – represents CRNAs who provide anesthesia services.207RA0401X: Anesthesiology Assistant – represents professionals assisting in anesthesia care under supervision.
Related Diagnoses
-
M17.10: Unilateral primary osteoarthritis, unspecified knee- Indicates osteoarthritis affecting one knee, relevant if the patient has joint disease contributing to surgical need.
-
M17.11: Unilateral primary osteoarthritis, right knee- Specifies osteoarthritis in the right knee, which may be part of the patient's overall joint pathology.
-
M17.12: Unilateral primary osteoarthritis, left knee- Specifies osteoarthritis in the left knee, relevant for patients with multi-joint disease.
-
Z96.651: Presence of right artificial knee joint- Indicates the patient has a right knee prosthesis, suggesting prior joint replacement and complex musculoskeletal history.
-
Z96.652: Presence of left artificial knee joint- Indicates the patient has a left knee prosthesis, relevant for surgical planning and anesthesia risk assessment.
Related CPT Codes
| CPT Code | Description | Clinical Relationship |
|---|---|---|
01210 | Anesthesia for open procedures involving hip joint; not otherwise specified | Used for open hip procedures that do not fall under more specific codes; may be an alternative to 01212 depending on the surgical details. |
01214 | Anesthesia for open procedures involving hip joint; total hip arthroplasty | Used when the procedure is a total hip replacement; may be used in conjunction with or as an alternative to 01212 if the surgery is arthroplasty rather than disarticulation. |
01215 | Anesthesia for open procedures involving hip joint; revision of total hip arthroplasty | Used for revision surgeries of hip replacements; related to 01212 when the surgical workflow involves revision rather than disarticulation. |
These codes are commonly used as alternatives based on the specific type of hip surgery performed.
National Reimbursement Benchmarks
For CPT code 01212, the national mean rate for BUCA (average commercial) is $218.06, which is substantially higher than the UnitedHealth Group mean rate of $65.57. Among commercial payers, Cigna has the highest mean rate at $553.31, while Aetna and Blue Cross Blue Shield are at $290.11 and $498.06, respectively.
Rate dispersion varies significantly across payers. UnitedHealth Group shows the tightest range, with a difference of $25.00 between the 75th and 25th percentiles. In contrast, Cigna exhibits the widest spread, with a $776.00 difference between its 75th and 25th percentiles. This indicates that Cigna's rates are more variable nationally, while UnitedHealth Group's rates are more consistent.
The table and chart below present the full breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska displays a wide spread in reimbursement rates for CPT code 01212, with Blue Cross Blue Shield offering the highest mean rate at $631.66 and UnitedHealth Group the lowest at $75.12. The rate spread, measured by the difference between the 75th and 25th percentiles, is most pronounced for Blue Cross Blue Shield ($208.25) and BUCA ($328.75), indicating significant variability in payments across providers. In contrast, Aetna, Cigna, and UnitedHealth Group show minimal spread, with their 25th, 50th, and 75th percentiles clustered closely together.
Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are substantially higher, while UnitedHealth Group and Cigna remain below or near national benchmarks. The table and chart below present the full breakdown of payer-specific rates in Alaska, highlighting the state's unique reimbursement landscape for CPT code 01212.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer in Alaska for CPT 01212, with a mean rate of $631.66.
- UnitedHealth Group offers the lowest mean rate at $75.12, significantly below both the state and national averages.
- Alaska's mean rates for most payers, especially Blue Cross Blue Shield and BUCA, are notably higher than their respective national averages, indicating a premium reimbursement environment.
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.