Summary & Overview
CPT 01402: Anesthesia for Total Knee Arthroplasty
CPT 01402 designates anesthesia services for open or arthroscopic knee procedures when performed for total knee arthroplasty. As a code tied to major joint replacement, it represents a high-acuity anesthesiology service commonly delivered in the inpatient hospital setting. Nationally, this code matters because total knee arthroplasty is a frequent orthopedic surgery with significant implications for perioperative resource use, anesthetic staffing models, and post-operative recovery planning.
Key payers covered in this review include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will find an overview of reimbursement and billing considerations for 01402, typical sites of service, and clinical context around anesthesia delivery for total knee arthroplasty. The content also outlines commonly used modifiers and associated clinician taxonomies, and lists relevant ICD-10 diagnoses and related CPT procedure codes for cross-reference.
This publication provides concise benchmarks for where 01402 is used in inpatient orthopedic care, highlights billing elements to be aware of when documenting anesthesia for total knee arthroplasty, and summarizes the clinical setting and coding relationships that inform coverage and claims processing at national payers. Data not available in the input will be identified explicitly in the detailed sections.
CPT Code Overview
CPT 01402 is for anesthesia services provided for open or surgical arthroscopic procedures on the knee joint specifically for total knee arthroplasty. The code describes the anesthesia component of care associated with performing a total knee replacement.
Service Type: Anesthesiology
Typical Site of Service: Inpatient Hospital (POS 21)
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with progressive knee pain and impaired ambulation is admitted to the inpatient hospital for a planned total knee arthroplasty. Preoperative evaluation by the surgical team documents unilateral primary osteoarthritis of the knee with radiographic joint space loss and failed conservative therapy. The anesthesiology team conducts a pre-anesthesia assessment, documents medical history, airway assessment, medication reconciliation, and anesthetic plan. On the day of surgery in Operating Room, anesthesia is provided for an open total knee arthroplasty, including induction, maintenance, intraoperative hemodynamic management, regional nerve block or neuraxial anesthesia as indicated, and emergence with handoff to post-anesthesia care unit (PACU) staff for postoperative monitoring and pain control.
Coding Specifications
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Common Modifiers
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AA: Anesthesia services performed personally by anesthesiologist. Use when the named physician anesthesiologist personally provides the anesthesia services for the case. -
QK: Medical direction of two, three, or four concurrent anesthesia procedures. Use when the physician medically directs multiple concurrent anesthesia procedures and meets documentation and supervision requirements for medical direction of 2–4 cases. -
QX: CRNA service with medical direction by a physician. Use when a Certified Registered Nurse Anesthetist furnishes anesthesia and a physician provides medical direction that meets requirements. -
QZ: CRNA service without medical direction by a physician. Use when a CRNA furnishes anesthesia services without physician medical direction. -
Associated Provider Taxonomies
| Taxonomy Code | Specialty Name |
|---|---|
207L00000X | Anesthesiology |
207LA0401X | Pain Medicine (Anesthesiology) |
367500000X | Certified Registered Nurse Anesthetist |
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Notes
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Use modifiers according to payer-specific rules and documented supervision or personal performance.
Related Diagnoses
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M17.10— Unilateral primary osteoarthritis, unspecified kneeClinical relevance: Represents primary degenerative joint disease affecting one knee and commonly indicates the need for total knee arthroplasty.
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M17.11— Unilateral primary osteoarthritis, right kneeClinical relevance: Specifies the right knee as the affected joint for which total knee arthroplasty may be performed.
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M17.12— Unilateral primary osteoarthritis, left kneeClinical relevance: Specifies the left knee as the affected joint for which total knee arthroplasty may be performed.
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M17.5— Other unilateral secondary osteoarthritis of kneeClinical relevance: Indicates secondary osteoarthritis (post-traumatic, inflammatory, or other cause) of one knee that may necessitate total knee arthroplasty.
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Z96.651— Presence of right artificial knee jointClinical relevance: Documents presence of a right knee prosthesis; relevant for anesthesia planning if revision or contralateral procedures are considered.
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Z96.652— Presence of left artificial knee jointClinical relevance: Documents presence of a left knee prosthesis; relevant for anesthesia planning if revision or contralateral procedures are considered.
Related CPT Codes
| CPT Code | Description |
|---|---|
27447 | Total knee arthroplasty |
27447is the surgical procedure for which01402provides the anesthesia service. In the clinical workflow,27447is the operative code billed by the surgeon while01402denotes the anesthesia care for that total knee arthroplasty. These codes are commonly used together: the surgeon bills27447and the anesthesia provider bills01402.27447serves as the primary operative code;01402is not an alternative but the anesthesia counterpart to that procedure.
National Reimbursement Benchmarks
National mean commercial rates exceed Medicare by a substantial margin when comparing Blue Universal Commercial Average (BUCA) to Medicare. BUCA's mean of $222.95 contrasts with Medicare at $0.00 in the input, indicating Medicare data is not provided in the appendix and BUCA serves as the available average commercial comparator.
Rate dispersion (P75 minus P25) varies notably across payers. Aetna shows the widest spread (P75 $634.67 minus P25 $44.00 = $590.67), followed by Cigna (P75 $609.00 minus P25 $88.75 = $520.25). Blue Cross Blue Shield exhibits a relatively tight spread (P75 $420.00 minus P25 $276.07 = $143.93), and UnitedHealth Group is the tightest in absolute terms (P75 $75.33 minus P25 $50.25 = $25.08). The table and chart below present the full breakdown.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska demonstrates a substantial rate spread for CPT code 01402, with Blue Cross Blue Shield showing the widest gap between the 25th and 75th percentiles ($228.00), indicating significant variability in reimbursement. In contrast, UnitedHealth Group and Aetna have much narrower spreads, suggesting more consistent rates across providers. The mean rates for most payers in Alaska, especially Blue Cross Blue Shield and Aetna, are considerably higher than their respective national averages, highlighting Alaska's elevated reimbursement environment for this code.
The table and chart below present the full breakdown of payer-specific rates in Alaska, including mean values and percentile distributions for Aetna, Blue Cross Blue Shield, Cigna, and UnitedHealth Group.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 01402 in Alaska, with a mean rate of $481.25.
- UnitedHealth Group offers the lowest mean rate at $74.78, significantly below both state and national averages.
- The rate spread in Alaska is notably wider than national benchmarks, with BCBS rates far exceeding national mean values.
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