Summary & Overview
CPT 01234: Anesthesia for Radical Resection of Upper Femur
CPT code 01234 represents anesthesia for open procedures involving the upper two-thirds of the femur, specifically for radical resection. This code is significant in the national healthcare landscape due to its application in complex orthopedic surgeries that require advanced anesthesia management. 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 insight into the clinical context of radical femur resection procedures, typical sites of service, and the role of anesthesia in supporting these high-acuity cases. The summary also highlights relevant billing modifiers, associated provider taxonomies, and common ICD-10 diagnoses linked to the procedure. Additionally, the publication offers benchmarks and policy updates that inform stakeholders about current trends and requirements for anesthesia billing in orthopedic surgery. This information is essential for understanding the complexities of coding, reimbursement, and payer policies related to anesthesia services for radical femur resection.
CPT Code Overview
CPT code 01234 is used to report anesthesia services for open procedures involving the upper two-thirds of the femur, specifically for radical resection. This code is classified under the anesthesia service type and is most commonly performed in an inpatient hospital setting (Place of Service 21). The procedure typically involves complex surgical intervention requiring specialized anesthesia care to ensure patient safety and comfort during radical resection of the femur.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult admitted to an inpatient hospital for a radical resection of the upper two-thirds of the femur. The patient may have a history of advanced osteoarthritis or complications related to a previous knee replacement. The surgical team, including an orthopedic surgeon, plans an open procedure to remove diseased or damaged bone tissue. Anesthesia services are provided throughout the operation, ensuring patient safety and comfort. The anesthesia provider may be an anesthesiologist or a certified registered nurse anesthetist (CRNA), and the procedure is performed in a hospital operating room setting.
Coding Specifications
Common Modifiers:
| Modifier Code | Description |
|---|---|
QS | Monitored anesthesia care service |
QX | CRNA service with medical direction by a physician |
- Modifier
QSis used when monitored anesthesia care is provided. - Modifier
QXis used when a CRNA delivers anesthesia services under the medical direction of a physician.
Associated Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207L00000X | Anesthesiology |
367500000X | Certified Registered Nurse Anesthetist |
207X00000X | Orthopaedic Surgery |
207L00000Xrepresents anesthesiologists.367500000Xrepresents certified registered nurse anesthetists.207X00000Xrepresents orthopedic surgeons.
Related Diagnoses
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M17.10: Unilateral primary osteoarthritis, unspecified knee- Indicates osteoarthritis affecting one knee, relevant for patients undergoing femur resection due to joint disease.
-
M17.11: Unilateral primary osteoarthritis, right knee- Specifies osteoarthritis in the right knee, which may necessitate radical femur resection.
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M17.12: Unilateral primary osteoarthritis, left knee- Specifies osteoarthritis in the left knee, potentially leading to surgical intervention.
-
Z96.651: Presence of right artificial knee joint- Indicates a prior knee replacement on the right side, relevant for surgical planning and anesthesia risk assessment.
-
Z96.652: Presence of left artificial knee joint- Indicates a prior knee replacement on the left side, important for clinical context and perioperative management.
Related CPT Codes
| CPT Code | Description |
|---|---|
01232 | Anesthesia for open procedures involving upper two‑thirds of femur; amputation |
01232is related to01234as both involve anesthesia for open procedures on the upper two-thirds of the femur.01232is used when the surgical procedure is an amputation, while01234is used for radical resection.- These codes are alternatives depending on the specific surgical intervention performed.
National Reimbursement Benchmarks
For CPT code 01234, national mean rates vary significantly across commercial payers. Cigna and Blue Cross Blue Shield have the highest mean rates at $454.82 and $426.26, respectively, while UnitedHealth Group is notably lower at $65.61. The BUCA average commercial mean rate is $191.52, which is substantially higher than typical Medicare rates for most codes, though Medicare-specific data is not available in the input.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, is widest for Cigna ($603.75) and Aetna ($428.00), indicating substantial variability in contracted rates. UnitedHealth Group shows the tightest range ($25.20), 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 01234, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($163.15), while Aetna, Cigna, and UnitedHealth Group display minimal spreads ($3.00 or less). This indicates that Blue Cross Blue Shield's rates vary considerably across providers, whereas other payers maintain more consistent payment levels. The mean rates in Alaska are notably higher than national averages for most payers, particularly for Blue Cross Blue Shield and BUCA, highlighting Alaska's unique reimbursement landscape.
The table and chart below present the full breakdown of payer-specific rates for CPT code 01234 in Alaska, including mean values and percentile distributions. These details provide a clear comparison of how each payer compensates providers within the state.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer in Alaska for CPT 01234, with a mean rate of $509.64.
- UnitedHealth Group offers the lowest mean rate at $74.78.
- Alaska's mean rates for most payers are significantly 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.