Summary & Overview
CPT 01274: Anesthesia for Upper Leg Artery Procedures, Bypass Graft & Embolectomy
CPT code 01274 covers anesthesia for procedures involving the arteries of the upper leg, including bypass grafts and femoral artery embolectomy. This code is significant for hospitals and providers specializing in vascular and orthopedic surgery, as it ensures proper billing and reimbursement for complex inpatient procedures requiring advanced anesthesia care. Nationally, the code is recognized by major commercial payers such as Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, reflecting its widespread applicability across diverse healthcare settings.
This publication provides a comprehensive overview of CPT code 01274, including payer coverage, clinical context, and relevant benchmarks. Readers will gain insight into the typical site of service, associated service lines, and the importance of accurate coding for inpatient vascular procedures. Policy updates and billing considerations are also discussed, helping stakeholders understand the evolving landscape of anesthesia reimbursement. The analysis includes comparisons to related CPT codes and highlights common modifiers used in billing, offering a clear picture of how this code fits within broader anesthesiology and surgical practices.
CPT Code Overview
CPT code 01274 is used to report anesthesia services for procedures involving the arteries of the upper leg, specifically including bypass graft and femoral artery embolectomy. This code falls under the anesthesiology service type and is typically performed in an inpatient setting, as it is designated as an inpatient-only procedure. The code is relevant for cases where specialized anesthesia care is required during complex vascular interventions in the upper leg.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult patient admitted to the hospital for an urgent femoral artery embolectomy due to acute limb ischemia. The patient may have a history of knee osteoarthritis or previous knee replacement, as indicated by the associated ICD-10 codes. The clinical workflow includes preoperative assessment by the anesthesiology team, administration of anesthesia for the surgical removal of an embolus from the femoral artery, and postoperative monitoring in an inpatient setting. The procedure is performed by a vascular or orthopedic surgeon, with anesthesia provided by an anesthesiologist or a certified registered nurse anesthetist (CRNA), often under medical direction.
Coding Specifications
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Modifiers:
QS: Monitored anesthesia care service. Used when the anesthesia provider delivers monitored anesthesia care (MAC) during the procedure.QX: CRNA service with medical direction by a physician. Used when a CRNA provides anesthesia services under the medical direction of a physician.
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Provider Taxonomies:
Taxonomy Code Specialty Name 207L00000XAnesthesiology 367500000XCertified Registered Nurse Anesthetist (CRNA) 207X00000XOrthopaedic Surgery -
Service Type:
- Anesthesiology
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Typical Site of Service:
- Inpatient (IPO – Inpatient‑Only Procedure)
Related Diagnoses
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M17.10: Unilateral primary osteoarthritis, unspecified knee- Indicates osteoarthritis affecting one knee, which may contribute to vascular complications or surgical planning.
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M17.11: Unilateral primary osteoarthritis, right knee- Specifies osteoarthritis in the right knee, relevant for patients with right-sided vascular issues or prior knee surgery.
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M17.12: Unilateral primary osteoarthritis, left knee- Specifies osteoarthritis in the left knee, relevant for left-sided procedures or complications.
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M17.0: Bilateral primary osteoarthritis of knee- Indicates osteoarthritis in both knees, which may impact mobility and perioperative risk.
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Z96.651: Presence of right artificial knee joint- Denotes a right knee prosthesis, important for surgical planning and anesthesia considerations.
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Z96.652: Presence of left artificial knee joint- Denotes a left knee prosthesis, relevant for patients with prior knee replacement and potential vascular complications.
Related CPT Codes
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01272: Anesthesia for procedures on the upper leg (except knee)- Used for anesthesia services during upper leg procedures that do not involve the knee. May be an alternative to
01274when the procedure is not related to the femoral artery.
- Used for anesthesia services during upper leg procedures that do not involve the knee. May be an alternative to
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01404: Anesthesia for open or surgical arthroscopic procedures on knee joint; disarticulation at knee- Used for anesthesia during open or arthroscopic knee surgeries, including knee disarticulation. This code is related when the surgical focus is the knee joint rather than the femoral artery.
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Clinical Workflow Relation:
01272and01404may be used as alternatives depending on the specific surgical site and procedure. They are not typically billed together with01274but may be relevant for similar or adjacent procedures.
National Reimbursement Benchmarks
For CPT code 01274, national mean rates among commercial payers show significant variation. The average rate for BUCA (the composite of major commercial payers) is $152.53, while Medicare rates are not available in the input. Among individual commercial payers, Cigna has the highest mean rate at $352.10, and UnitedHealth Group has the lowest at $65.49.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies notably across payers. Blue Cross Blue Shield exhibits the tightest range ($140.50), indicating more consistent rates, while Cigna shows the widest spread ($430.00), reflecting substantial variability. Aetna and BUCA also display considerable dispersion, with ranges of $324.00 and $178.07, respectively. UnitedHealth Group has a relatively narrow range of $25.00.
The table and chart below present a detailed breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska shows a wide spread in reimbursement rates for CPT code 01274 across commercial payers. The rate spread, calculated as the difference between the 75th and 25th percentiles, is most pronounced for Blue Cross Blue Shield ($212.80) and BUCA ($231.07), indicating substantial variability in payments. In contrast, Aetna and UnitedHealth Group have minimal spreads ($0 and $3, respectively), suggesting more uniform rates among providers contracted with these payers.
Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are notably higher, while Cigna and UnitedHealth Group are closer to or slightly above national benchmarks. The table and chart below present the full breakdown of payer-specific rates in Alaska for CPT code 01274.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 01274 in Alaska, with a mean rate of $416.16.
- 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.