Summary & Overview
CPT 01214: Anesthesia for Total Hip Arthroplasty
CPT code 01214 represents anesthesia services for open procedures involving the hip joint, with a focus on total hip arthroplasty. This code is nationally significant due to the prevalence of hip replacement surgeries and the essential role of anesthesia in these procedures. 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 service.
Readers will gain insights into clinical benchmarks, policy updates, and billing practices related to anesthesia for total hip arthroplasty. The summary includes information on common modifiers used in billing, associated provider taxonomies, and relevant ICD-10 diagnoses that may be linked to hip replacement procedures. Additionally, the publication highlights related CPT codes and outlines typical sites of service, offering a clear context for both clinical and administrative stakeholders. This resource is designed to inform healthcare professionals, billing specialists, and policy analysts about the current landscape for anesthesia services in hip arthroplasty, supporting accurate coding and understanding of payer requirements.
CPT Code Overview
CPT code 01214 is used to report anesthesia services for open procedures involving the hip joint, specifically for total hip arthroplasty. This code applies when an anesthesia provider delivers care during a surgical replacement of the hip joint. The typical site of service for this procedure is the operating room, which may be located in a hospital inpatient or outpatient setting. Anesthesia for total hip arthroplasty is a critical component in ensuring patient comfort and safety during complex orthopedic surgery.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult patient with advanced osteoarthritis of the hip joint, resulting in significant pain and limited mobility. The patient is scheduled for a total hip arthroplasty (hip replacement surgery) in a hospital operating room. An anesthesia provider, such as an anesthesiologist or a certified registered nurse anesthetist (CRNA), administers anesthesia for the open surgical procedure. The clinical workflow includes preoperative assessment, induction and maintenance of anesthesia during the surgery, and postoperative monitoring in the recovery area.
Coding Specifications
Common Modifiers:
| Modifier Code | Description |
|---|---|
AA | Anesthesia services performed personally by anesthesiologist |
QK | Medical direction of two, three, or four concurrent anesthesia procedures |
QX | CRNA service with medical direction by a physician |
QY | Medical direction of one CRNA by an anesthesiologist |
Associated Provider Taxonomies:
207L00000X- Anesthesiology207LA0401X- Pain Medicine (Anesthesiology)367H00000X- Anesthesiologist Assistant367500000X- Certified Registered Nurse Anesthetist
These taxonomies represent providers specializing in anesthesia and pain management, including physicians, assistants, and nurse anesthetists.
Related Diagnoses
M17.10- Unilateral primary osteoarthritis, unspecified knee- Relevant for patients with osteoarthritis affecting one knee, which may coexist with hip osteoarthritis requiring arthroplasty.
M17.11- Unilateral primary osteoarthritis, right knee- Indicates osteoarthritis in the right knee; may be present in patients undergoing hip replacement due to multi-joint disease.
M17.12- Unilateral primary osteoarthritis, left knee- Indicates osteoarthritis in the left knee; similar clinical relevance as above.
M17.5- Other unilateral secondary osteoarthritis of knee- Represents secondary osteoarthritis, which may be associated with systemic conditions affecting multiple joints.
Z96.651- Presence of right artificial knee joint- Indicates a patient with a prior right knee replacement, often seen in those with advanced joint disease.
Z96.652- Presence of left artificial knee joint- Indicates a patient with a prior left knee replacement, relevant for patients with a history of joint arthroplasty.
These diagnoses are clinically relevant as they reflect the typical comorbidities and surgical history of patients undergoing total hip arthroplasty with anesthesia services coded as 01214.
Related CPT Codes
27130- Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty)
27130 is the surgical procedure code for total hip arthroplasty, which is the operation for which anesthesia is provided under 01214. These codes are commonly used together in the clinical workflow: 27130 for the surgery and 01214 for the anesthesia services. 27130 is not an alternative to 01214, but rather a complementary code representing the surgical aspect of the procedure.
National Reimbursement Benchmarks
National mean rates for CPT code 01214 show that commercial payers such as Aetna, Blue Cross Blue Shield, Cigna, and BUCA (average commercial) reimburse significantly higher amounts compared to UnitedHealth Group. The mean rate for BUCA is $257.47, while UnitedHealth Group is notably lower at $65.58. Medicare data is not available in the input for comparison.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Aetna exhibits the widest spread ($700.00 - $45.00 = $655.00), indicating substantial variability in rates. Blue Cross Blue Shield and Cigna also show considerable dispersion, with ranges of $195.74 and $603.67, respectively. UnitedHealth Group has the tightest range ($75.67 - $50.33 = $25.34), suggesting more consistent reimbursement levels.
The table and chart below present the full breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a wide spread in reimbursement rates for CPT code 01214, with Blue Cross Blue Shield showing the largest rate spread between the 25th and 75th percentiles ($163.03), while Aetna and UnitedHealth Group have minimal spreads (less than $5). This indicates that some payers, such as Blue Cross Blue Shield and BUCA, offer a broader range of rates, while others maintain more consistent payment levels. Compared to national averages, Alaska's mean rates for Aetna, Blue Cross Blue Shield, and BUCA are substantially higher, reflecting a premium reimbursement environment in the state. Cigna and UnitedHealth Group, however, remain below national averages, highlighting significant variation among payers.
The table and chart below present the full breakdown of mean rates and percentile distributions for each payer in Alaska, allowing for direct comparison across the major commercial insurers.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer in Alaska for CPT 01214, with a mean rate of $509.32.
- 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 Aetna 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.