Summary & Overview
CPT 01380: Anesthesia for Knee Arthroscopy Procedures
CPT code 01380 represents anesthesia for arthroscopic procedures on the knee joint, a common intervention in orthopedic surgery. This code is nationally significant as it ensures precise billing and documentation for anesthesia services during minimally invasive knee operations, which are frequently performed in outpatient hospital settings. 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 insights into the clinical context of knee arthroscopy, typical sites of service, and the role of anesthesia in these procedures. The summary also highlights relevant modifiers, associated provider taxonomies, and common ICD-10 diagnoses linked to knee pathology, offering a well-rounded perspective for stakeholders. Additionally, related CPT codes for knee procedures are discussed, supporting a broader understanding of coding practices and reimbursement trends. This resource is designed to inform healthcare professionals, billing specialists, and policy analysts about current benchmarks and updates in medical billing for anesthesia services in knee arthroscopy.
CPT Code Overview
CPT code 01380 is used to report anesthesia services for arthroscopic procedures performed on the knee joint. 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 minimally invasive knee surgeries, ensuring proper reimbursement and compliance with national standards.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting to the outpatient hospital with knee pain, instability, or mechanical symptoms such as locking or catching. The patient may have a history of chronic instability, osteoarthritis, or a recent meniscal tear. After clinical evaluation and imaging, the orthopedic surgeon recommends an arthroscopic procedure on the knee joint to address the underlying pathology. An anesthesia provider, such as an anesthesiologist, certified registered nurse anesthetist (CRNA), or anesthesiology assistant, administers anesthesia for the arthroscopic procedure. The workflow includes preoperative assessment, administration of anesthesia, intraoperative monitoring, and postoperative recovery in the outpatient setting.
Coding Specifications
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Modifiers:
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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 |
|---|---|
207L00000X | Anesthesiology |
367500000X | Certified Registered Nurse Anesthetist (CRNA) |
207RA0401X | Anesthesiology Assistant |
These taxonomies represent the specialties eligible to provide anesthesia services for knee arthroscopy procedures.
Related Diagnoses
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M23.50: Chronic instability of knee, unspecified knee- Indicates ongoing instability of the knee joint, often requiring arthroscopic evaluation and treatment.
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M17.11: Unilateral primary osteoarthritis, right knee- Represents degenerative changes in the right knee, which may necessitate arthroscopic intervention for diagnosis or management.
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M17.12: Unilateral primary osteoarthritis, left knee- Represents degenerative changes in the left knee, potentially leading to arthroscopic procedures.
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S83.241A: Other tear of lateral meniscus, current injury, right knee, initial encounter- Describes an acute meniscal tear in the right knee, commonly treated with arthroscopic surgery.
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S83.242A: Other tear of lateral meniscus, current injury, left knee, initial encounter- Describes an acute meniscal tear in the left knee, also frequently managed with arthroscopy.
Each diagnosis is clinically relevant as it represents conditions that may require arthroscopic procedures on the knee, for which anesthesia services coded as 01380 are provided.
Related CPT Codes
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29881: Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving)- Used when the surgeon performs a meniscectomy on either the medial or lateral meniscus during knee arthroscopy. Commonly paired with anesthesia code
01380.
- Used when the surgeon performs a meniscectomy on either the medial or lateral meniscus during knee arthroscopy. Commonly paired with anesthesia code
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29880: Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving)- Used when both medial and lateral meniscectomies are performed in the same arthroscopic session. Also commonly paired with
01380for anesthesia.
- Used when both medial and lateral meniscectomies are performed in the same arthroscopic session. Also commonly paired with
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20610: Arthrocentesis, aspiration and/or injection into a major joint or bursa- Represents a less invasive procedure, sometimes performed instead of arthroscopy. Not typically paired with
01380unless anesthesia is required for aspiration/injection.
- Represents a less invasive procedure, sometimes performed instead of arthroscopy. Not typically paired with
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29876: Arthroscopy, knee, surgical; synovectomy, major, 2 or more compartments- Used for arthroscopic synovectomy involving two or more compartments of the knee. Anesthesia code
01380is used for these procedures as well.
- Used for arthroscopic synovectomy involving two or more compartments of the knee. Anesthesia code
These codes are related to 01380 as they represent the surgical procedures for which anesthesia is provided. 29881, 29880, and 29876 are commonly used together with 01380 in the clinical workflow, while 20610 may be an alternative in less complex cases.
National Reimbursement Benchmarks
For CPT code 01380, national mean rates among commercial payers show notable variation. The average commercial rate (BUCA) is $107.02, while individual payer means range from $65.57 for UnitedHealth Group to $197.87 for Cigna. Medicare rates are not available in the input for comparison.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, is widest for Aetna ($184.37) and Cigna ($173.00), indicating significant variability in contracted rates. Blue Cross Blue Shield has a tighter range ($87.25), and UnitedHealth Group shows the narrowest spread ($25.13), 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 significant spread in reimbursement rates for CPT code 01380 across major commercial payers. The rate spread, calculated as the difference between the 75th and 25th percentiles, is most pronounced for Blue Cross Blue Shield ($90.55) and BUCA ($91.51), indicating substantial variability in payments. In contrast, Aetna and UnitedHealth Group show minimal spread ($0), suggesting consistent rates across providers. Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are considerably higher, while UnitedHealth Group and Cigna are closer to or below national benchmarks.
The table and chart below present the full breakdown of mean rates and percentile values for each payer in Alaska, highlighting the differences in reimbursement levels and variability across the market.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 01380 in Alaska, with a mean rate of $219.23.
- UnitedHealth Group offers the lowest mean rate at $74.78.
- Alaska's mean rates for most payers are notably 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.