Summary & Overview
CPT 01360: Anesthesia for Procedures on the Knee and Popliteal Area
CPT code 01360 represents anesthesia services for procedures on the knee and popliteal area, a critical component in surgical care for orthopedic and related interventions. This code is widely recognized across the United States and is accepted by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. The publication provides a comprehensive overview of the clinical context for 01360, including its typical use in outpatient hospital settings and its relevance to anesthesiology professionals.
Readers will gain insight into payer coverage, common modifiers, and associated provider taxonomies, as well as related ICD-10 diagnoses and CPT codes. The article also highlights policy updates and benchmarks relevant to anesthesia billing for knee and popliteal procedures. Understanding the nuances of 01360 is essential for healthcare organizations, billing professionals, and clinicians seeking to ensure accurate coding and compliance with payer requirements. The summary offers a clear, concise guide to the code's national significance and practical application in medical billing and clinical practice.
CPT Code Overview
CPT code 01360 is used to report anesthesia services for procedures performed on the knee and popliteal area. This code falls under the anesthesiology service type and is typically utilized in an outpatient hospital setting (Place of Service 22). The code is essential for accurately documenting and billing anesthesia care provided during surgical interventions involving the knee or popliteal region, ensuring proper reimbursement and compliance with national standards.
Clinical & Coding Specifications
Clinical Context
A patient presents to the outpatient hospital with knee pain or injury, such as a fracture or chronic pain, requiring a surgical or diagnostic procedure on the knee or popliteal area. The anesthesiology team evaluates the patient, who is typically healthy (modifier P1), and provides anesthesia services for the procedure. The workflow involves preoperative assessment, administration of anesthesia, monitoring during the procedure, and postoperative care. Procedures may include arthrocentesis, arthroplasty, or surgical repair, with anesthesia provided by an anesthesiology physician or a certified registered nurse anesthetist.
Coding Specifications
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Modifiers:
Modifier Code Description Usage Context QSMonitored anesthesia care service Used when anesthesia is provided as monitored anesthesia care (MAC) rather than general anesthesia. P1A normal healthy patient Used to indicate the physical status of the patient as normal and healthy. -
Provider Taxonomies:
Taxonomy Code Specialty Name 207L00000XAnesthesiology Physician 367500000XCertified Registered Nurse Anesthetist
These taxonomies represent providers qualified to deliver anesthesia services for knee and popliteal area procedures.
Related Diagnoses
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S42.301A- Fracture of unspecified part of right humerus, initial encounter for closed fracture- Indicates a traumatic injury; relevant if anesthesia is needed for surgical repair or pain management.
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S42.302A- Fracture of unspecified part of left humerus, initial encounter for closed fracture- Similar to above, for the left side; may require anesthesia for surgical intervention.
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M25.521- Pain in right elbow- Chronic or acute pain that may necessitate diagnostic or therapeutic procedures requiring anesthesia.
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M25.522- Pain in left elbow- As above, for the left elbow; anesthesia may be needed for procedures addressing pain.
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M77.10- Lateral epicondylitis, unspecified elbow- Represents a musculoskeletal condition that could require intervention with anesthesia for pain relief or surgical management.
Related CPT Codes
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01810- Anesthesia for open or surgical arthroscopic procedures on knee joint- Used for anesthesia during more extensive open or arthroscopic knee procedures; may be an alternative to
01360depending on procedure specifics.
- Used for anesthesia during more extensive open or arthroscopic knee procedures; may be an alternative to
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01400- Anesthesia for open or surgical arthroscopic procedures on knee joint- Similar to
01810, covers anesthesia for open or arthroscopic knee procedures; often used interchangeably with01360for certain cases.
- Similar to
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20610- Arthrocentesis, aspiration and/or injection into a joint or bursa- Represents the surgical or diagnostic procedure for which anesthesia (
01360) may be provided; commonly paired in workflow.
- Represents the surgical or diagnostic procedure for which anesthesia (
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24357- Arthroplasty, elbow; with distal humeral prosthetic replacement- While focused on the elbow, this code may be relevant in cases where anesthesia is required for procedures involving both knee and elbow, or for differential diagnosis and treatment planning.
National Reimbursement Benchmarks
For CPT code 01360, national mean rates among commercial payers vary significantly. The average commercial rate (BUCA) is $165.23, while UnitedHealth Group (UHC) is notably lower at $65.61. Blue Cross Blue Shield (BCBS), Aetna, and Cigna all report higher mean rates, with Cigna leading at $298.14. Medicare rates are not available in the input.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, is widest for Aetna ($343.00) and Cigna ($345.00), indicating substantial variability in contracted rates. Blue Cross Blue Shield shows a tighter range ($121.10), and UnitedHealth Group has the narrowest spread ($25.25), 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 demonstrates a wide spread in reimbursement rates for CPT code 01360, with Blue Cross Blue Shield showing the largest rate spread (75th percentile minus 25th percentile: $95.40), while Aetna and UnitedHealth Group have minimal spreads ($0.00 and $3.00, respectively). This indicates that Blue Cross Blue Shield's rates vary considerably across providers, whereas Aetna and UnitedHealth Group maintain consistent rates. Compared to national averages, Alaska's mean rates for most payers are higher, except for Cigna and UnitedHealth Group, which are notably lower than their national benchmarks.
The table and chart below present the full breakdown of mean rates and percentile distributions by payer for Alaska, highlighting the significant differences in reimbursement across payers.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 01360 in Alaska, with a mean rate of $327.70.
- UnitedHealth Group offers the lowest mean rate at $74.78, significantly below both the state and national averages.
- Cigna's mean rate in Alaska ($89.33) is much lower than its national average ($298.14), indicating a substantial deviation.
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.