Summary & Overview
CPT 01272: Anesthesia for Upper Leg Vascular Procedures (Femoral Artery)
CPT code 01272 is a critical billing code used to report anesthesia services for procedures on the upper leg, excluding the knee, with a focus on ligation and bypass graft placement of the femoral artery. This code is nationally relevant for hospitals and anesthesia providers, as it ensures proper documentation and reimbursement for complex vascular interventions. The publication covers major commercial payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, providing a comprehensive overview of payer coverage and policy considerations.
Readers will gain insight into the clinical context of 01272, including its typical use in hospital outpatient and inpatient settings. The summary highlights benchmarks, policy updates, and the importance of accurate coding for anesthesia services in vascular surgery. The article also addresses common modifiers, associated taxonomies, and relevant ICD-10 diagnoses, offering a well-rounded perspective for healthcare professionals and billing specialists. By understanding the nuances of 01272, stakeholders can stay informed about national trends and requirements for anesthesia billing in upper leg vascular procedures.
CPT Code Overview
CPT code 01272 is designated for anesthesia services provided during procedures on the upper leg, excluding the knee. Specifically, this code applies to cases involving ligation and bypass graft placement of the femoral artery. The service type is anesthesia, and it is typically performed in a hospital outpatient or inpatient setting under Part A PPS services. This code is essential for accurately reporting and reimbursing anesthesia care associated with complex vascular procedures on the upper leg.
Clinical & Coding Specifications
Clinical Context
A patient presents to the hospital with a vascular condition requiring surgical intervention on the upper leg, such as ligation or bypass graft placement of the femoral artery. The procedure is performed in a hospital outpatient or inpatient setting. An anesthesia provider, such as an anesthesiologist, anesthesiology assistant, or certified registered nurse anesthetist, administers anesthesia services to ensure patient comfort and safety during the operation. The clinical workflow involves preoperative assessment, induction and maintenance of anesthesia, intraoperative monitoring, and postoperative care. Common clinical scenarios include patients with arterial blockages, trauma, or vascular disease affecting the femoral artery, often associated with pain, fractures, or sprains in the lower extremities.
Coding Specifications
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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. Used when a certified registered nurse anesthetist provides anesthesia under the medical direction of a physician.
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Provider Taxonomies:
Taxonomy Code Specialty Name 207L00000XAnesthesiology 207RA0401XAnesthesiology Assistant 367500000XCertified Registered Nurse Anesthetist
These taxonomies represent the specialties eligible to provide anesthesia services for this procedure.
Related Diagnoses
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S82.101A: Fracture of upper end of right tibia, initial encounter for closed fracture- Relevant when the patient has sustained a fracture near the knee, which may necessitate vascular intervention or anesthesia for surgical repair.
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S82.102A: Fracture of upper end of left tibia, initial encounter for closed fracture- Similar to
S82.101A, this code applies to fractures on the left side, potentially requiring anesthesia for surgical management.
- Similar to
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M25.571: Pain in right ankle and joints of right foot- Indicates pain in the lower extremity, which may be associated with vascular or orthopedic procedures requiring anesthesia.
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M25.572: Pain in left ankle and joints of left foot- Represents pain on the left side, relevant for procedures addressing underlying causes or during postoperative care.
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S93.401A: Sprain of unspecified ligament of right ankle, initial encounter- Used when the patient has a sprain, which may be part of a broader clinical scenario involving vascular or orthopedic surgery in the upper leg.
Related CPT Codes
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01270: Anesthesia for procedures on the arteries of the upper leg that includes placement of a bypass graft (under anesthesia for procedures on the upper leg [except knee]).- This code is used for anesthesia services during arterial procedures in the upper leg, specifically when a bypass graft is placed. It is closely related to
01272and may be used as an alternative depending on the exact surgical procedure.
- This code is used for anesthesia services during arterial procedures in the upper leg, specifically when a bypass graft is placed. It is closely related to
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01274: Anesthesia for procedures on the upper leg (except knee) - surgical removal of embolus and placement of a bypass graft of the femoral artery in the upper leg.- This code applies when the procedure involves removal of an embolus and placement of a bypass graft in the femoral artery. It is related to
01272and may be used in cases where embolus removal is performed in addition to bypass graft placement.
- This code applies when the procedure involves removal of an embolus and placement of a bypass graft in the femoral artery. It is related to
These codes are commonly used as alternatives or in conjunction with 01272 depending on the specific surgical intervention performed.
National Reimbursement Benchmarks
National mean rates for CPT code 01272 show that Cigna and Blue Cross Blue Shield have the highest average reimbursement, at $249.04 and $233.56 respectively, while UnitedHealth Group is notably lower at $65.55. The BUCA (average commercial) mean rate stands at $120.17, which is significantly higher than typical Medicare rates, though Medicare data is not available in the input for this code.
Rate dispersion varies considerably across payers. UnitedHealth Group has the tightest range between the 25th and 75th percentiles ($75.29 - $50.17 = $25.12), indicating less variability in contracted rates. In contrast, Cigna exhibits the widest spread ($348.00 - $89.00 = $259.00), reflecting substantial variation in reimbursement levels. Blue Cross Blue Shield and Aetna also show broad ranges, suggesting diverse contract terms across providers.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska demonstrates a substantial rate spread for CPT code 01272, particularly with Blue Cross Blue Shield, where the difference between the 75th and 25th percentiles is $72.70 ($298.50 minus $225.80). Other payers, such as Aetna and UnitedHealth Group, show minimal spread, with all percentiles clustered closely around $72.00 to $75.00, indicating limited variability in reimbursement rates. Cigna also exhibits a narrow spread, with rates ranging from $85.00 to $93.00.
Compared to national averages, Alaska's mean rates for Aetna and Blue Cross Blue Shield are notably higher, while Cigna's mean rate is much lower than its national benchmark. The table and chart below present the full breakdown of payer-specific reimbursement rates for CPT code 01272 in Alaska.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 01272 in Alaska, with a mean rate of $267.13.
- UnitedHealth Group offers the lowest mean rate in Alaska at $74.78.
- Alaska's mean rates for most payers are higher than their respective national averages, except for Cigna, which is significantly lower in Alaska compared to its national mean.
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.