Summary & Overview
CPT 01430: Anesthesia for Knee Joint Procedures, Not Otherwise Specified
CPT code 01430 represents anesthesia for procedures on the knee joint that are not otherwise specified, serving as a foundational billing code for anesthesiology services in orthopedic and surgical settings. This code is widely used across outpatient hospital environments, supporting a variety of knee interventions where specific anesthesia codes do not apply. Nationally, CPT 01430 is recognized by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, ensuring broad coverage for patients undergoing knee procedures.
This publication provides a comprehensive overview of CPT 01430, including payer coverage, clinical context, and related coding benchmarks. Readers will gain insight into the typical use cases for this code, its relevance in anesthesiology practice, and how it fits within the broader landscape of knee procedure billing. The summary also highlights common modifiers and associated provider taxonomies, offering clarity on who may bill for these services. Policy updates and clinical benchmarks are discussed to inform stakeholders about current trends and requirements in anesthesia billing for knee procedures. This resource is designed to support healthcare professionals, administrators, and policy analysts seeking up-to-date information on anesthesia coding for knee interventions.
CPT Code Overview
CPT 01430 is designated for anesthesia services provided during procedures on the knee joint that are not otherwise specified. This code is utilized by professionals in the field of anesthesiology and is most commonly billed in the outpatient hospital setting, specifically at Place of Service 22. The code covers a range of knee procedures where anesthesia is required but does not fall under more specific anesthesia codes for knee surgeries. It is a key billing code for anesthesiology providers supporting orthopedic and surgical interventions on the knee.
Clinical & Coding Specifications
Clinical Context
A patient presents to the outpatient hospital with significant knee pain and limited mobility, often due to conditions such as unilateral primary osteoarthritis or a recent ligament sprain. The orthopedic surgeon schedules a procedure on the knee joint that does not fall under more specific surgical categories. An anesthesiology provider, such as an anesthesiology physician, certified registered nurse anesthetist, or anesthesiology assistant, administers anesthesia for the procedure. The clinical workflow includes preoperative assessment, anesthesia induction, intraoperative monitoring, and postoperative recovery, ensuring patient comfort and safety throughout the intervention.
Coding Specifications
Common Modifiers:
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QS- Monitored anesthesia care service: Used when the anesthesia provider delivers monitored anesthesia care, typically for procedures where deep sedation or general anesthesia is not required. -
QX- CRNA service with medical direction by a physician: Applied when a certified registered nurse anesthetist (CRNA) provides anesthesia services under the medical direction of a physician.
Associated Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207L00000X | Anesthesiology Physician |
367500000X | Certified Registered Nurse Anesthetist (CRNA) |
207RA0401X | Anesthesiology Assistant |
Related Diagnoses
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M17.11- Unilateral primary osteoarthritis, right knee- Indicates degenerative changes in the right knee joint, often leading to pain and functional impairment requiring anesthesia for intervention.
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M17.12- Unilateral primary osteoarthritis, left knee- Represents similar osteoarthritic changes in the left knee, relevant for procedures addressing joint pain or dysfunction.
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S83.241A- Sprain of medial collateral ligament of right knee, initial encounter- Reflects an acute injury to the right knee's medial collateral ligament, necessitating procedural intervention under anesthesia.
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S83.242A- Sprain of medial collateral ligament of left knee, initial encounter- Denotes an acute sprain of the left knee's medial collateral ligament, relevant for anesthesia during repair or evaluation.
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M25.561- Pain in right knee- Documents significant pain in the right knee, which may prompt diagnostic or therapeutic procedures requiring anesthesia.
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M25.562- Pain in left knee- Indicates pain in the left knee, supporting the need for anesthesia during knee joint procedures.
Related CPT Codes
| CPT Code | Description |
|---|---|
01402 | Anesthesia for open or surgical arthroscopic procedures on knee joint |
01404 | Anesthesia for total knee arthroplasty |
29881 | Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) |
29880 | Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) |
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01402and01404are alternative anesthesia codes for more specific knee procedures, such as arthroscopy or total knee replacement. -
29881and29880are surgical procedure codes for knee arthroscopy with meniscectomy, which may be performed in conjunction with anesthesia services billed under01430when the procedure is not otherwise specified. -
These codes are commonly used together when anesthesia is required for the listed surgical procedures, or as alternatives when the procedure type is more specifically defined.
National Reimbursement Benchmarks
National mean rates for CPT code 01430 show that Cigna has the highest average reimbursement at $198.38, while UnitedHealth Group is the lowest among commercial payers at $65.54. The BUCA (average commercial) mean rate stands at $100.09, which is notably higher than UnitedHealth Group but lower than Blue Cross Blue Shield and Cigna. Medicare data is not available in the input for comparison.
Rate dispersion varies significantly across payers. UnitedHealth Group exhibits the tightest range, with a difference of $24.75 between the 75th and 25th percentiles, indicating less variability in rates. In contrast, Aetna and Cigna show much wider dispersions, with ranges of $168.00 and $172.67 respectively, reflecting greater variability in contracted rates. Blue Cross Blue Shield and BUCA also display moderate dispersion.
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's reimbursement rates for CPT code 01430 show a wide spread across payers, with Blue Cross Blue Shield offering the highest mean rate at $219.48 and UnitedHealth Group the lowest at $74.78. The rate spread, calculated as the difference between the 75th and 25th percentiles, is most pronounced for Blue Cross Blue Shield ($91.47), indicating significant variability in negotiated rates. In contrast, Aetna and UnitedHealth Group display minimal spread, with all percentile values clustered at $72.00–$75.00, suggesting standardized contracts or limited negotiation.
Compared to national averages, Alaska's mean rates for most payers are higher, especially for BUCA and Blue Cross Blue Shield. The table and chart below present the full breakdown of payer-specific rates, highlighting the regional differences and the substantial premium for certain payers in Alaska.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 01430 in Alaska, with a mean rate of $219.48.
- UnitedHealth Group offers the lowest mean rate at $74.78, significantly below both the state and national averages.
- The mean rate for BUCA in Alaska ($163.40) is notably higher than the national BUCA average ($100.09), indicating a substantial regional premium.
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.