Summary & Overview
CPT 01464: Anesthesia for Arthroscopic Procedures of Ankle and Foot
CPT code 01464 covers anesthesia services for arthroscopic procedures of the ankle and/or foot, a critical component in orthopedic surgical care. This code is nationally recognized and used by anesthesiology professionals to document and bill for anesthesia management during minimally invasive surgeries targeting the ankle or foot. The code is relevant for hospital-based operating room settings, where these procedures are most frequently performed.
Major commercial payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare provide coverage for services billed under CPT code 01464. Understanding payer policies and coverage is essential for accurate billing and compliance in anesthesiology practices.
This publication offers a comprehensive overview of CPT code 01464, including clinical context, payer coverage, and related coding benchmarks. Readers will gain insight into the scope of services represented by this code, typical sites of service, and its role within the broader landscape of anesthesia billing for orthopedic procedures. The summary also highlights associated modifiers, taxonomies, and related CPT codes, providing a clear framework for understanding how 01464 fits into anesthesiology coding and reimbursement. Policy updates and clinical benchmarks are discussed to inform stakeholders about current trends and requirements in anesthesia billing for arthroscopic ankle and foot procedures.
CPT Code Overview
CPT code 01464 is designated for anesthesia services provided during arthroscopic procedures of the ankle and/or foot. This code is utilized by anesthesiology professionals to indicate the administration and management of anesthesia for these minimally invasive surgical interventions. The typical site of service for procedures billed under CPT code 01464 is the Operating Room (POS 21), reflecting the hospital-based setting where such arthroscopic surgeries are commonly performed. The service type is Anesthesiology, encompassing the full scope of perioperative anesthesia care for patients undergoing ankle or foot arthroscopy.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting with chronic ankle pain and limited mobility due to osteoarthritis or prior joint replacement. The patient is scheduled for an arthroscopic procedure of the ankle and/or foot in the operating room (POS 21) to address joint pathology, such as debridement or evaluation of the joint. An anesthesiology provider, such as an anesthesiologist or CRNA, administers anesthesia to ensure patient comfort and safety during the arthroscopic intervention. The clinical workflow includes preoperative assessment, induction and maintenance of anesthesia, intraoperative monitoring, and postoperative recovery.
Coding Specifications
Common Modifiers:
| Modifier | Description |
|---|---|
AA | Anesthesia services performed personally by anesthesiologist |
QK | Medical direction of two, three, or four concurrent anesthesia procedures |
QX | CRNA service with medical direction by a physician |
QY | Medical direction of one CRNA by an anesthesiologist |
- Modifier
AAis used when the anesthesiologist personally performs the anesthesia service. - Modifier
QKis used when the anesthesiologist provides medical direction for two to four concurrent procedures. - Modifier
QXis used when a CRNA provides the service with physician medical direction. - Modifier
QYis used when an anesthesiologist provides medical direction for one CRNA.
Associated Provider Taxonomies:
| Taxonomy Code | Specialty |
|---|---|
207L00000X | Anesthesiology |
207LA0401X | Pain Medicine (Anesthesiology) |
367H00000X | Anesthesiologist Assistant |
367500000X | Certified Registered Nurse Anesthetist |
- These taxonomies represent providers qualified to deliver anesthesia services for arthroscopic procedures of the ankle and/or foot.
Related Diagnoses
-
M17.10- Unilateral primary osteoarthritis, unspecified knee- Relevant for patients with osteoarthritis affecting the knee, which may coexist with ankle pathology requiring arthroscopy.
-
M17.11- Unilateral primary osteoarthritis, right knee- Indicates osteoarthritis in the right knee; may be present in patients undergoing ankle/foot arthroscopy due to lower extremity joint disease.
-
M17.12- Unilateral primary osteoarthritis, left knee- Indicates osteoarthritis in the left knee; relevant for patients with multi-joint involvement.
-
M17.5- Other unilateral secondary osteoarthritis of knee- Represents secondary osteoarthritis, which may be associated with prior injury or surgery, relevant in patients with complex lower extremity pathology.
-
Z96.651- Presence of right artificial knee joint- Indicates a history of knee replacement; patients may require ankle/foot arthroscopy due to altered biomechanics or joint pain.
-
Z96.652- Presence of left artificial knee joint- Indicates a history of left knee replacement; relevant for patients with ongoing lower extremity issues necessitating arthroscopic intervention.
Related CPT Codes
| CPT Code | Description | Clinical Relationship |
|---|---|---|
01462 | Anesthesia for all closed procedures on lower leg, ankle, and foot | Used for closed procedures; alternative to 01464 for non-arthroscopic cases |
01470 | Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; not otherwise specified | Used for soft tissue procedures; not specific to arthroscopy |
01472 | Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; repair of ruptured Achilles tendon, with or without graft | Used for Achilles tendon repair; not typically combined with 01464 |
01474 | Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; gastrocnemius recession (eg, Strayer procedure) | Used for gastrocnemius recession; alternative for specific muscle procedures |
01480 | Anesthesia for open procedures on bones of lower leg, ankle, and foot; not otherwise specified | Used for open bone procedures; alternative to arthroscopic anesthesia |
01482 | Anesthesia for open procedures on bones of lower leg, ankle, and foot; radical resection (including below knee amputation) | Used for radical resection or amputation; not typically combined with 01464 |
01484 | Anesthesia for open procedures on bones of lower leg, ankle, and foot; osteotomy or osteoplasty of tibia and/or fibula | Used for osteotomy/osteoplasty; alternative for open procedures |
01486 | Anesthesia for open procedures on bones of lower leg, ankle, and foot; total ankle replacement | Used for total ankle replacement; not typically combined with 01464 |
01490 | Anesthesia for lower leg cast application, removal, or repair | Used for cast procedures; not typically combined with 01464 |
- Codes such as
01462,01470, and01480are alternatives depending on the surgical approach (closed, open, or arthroscopic). - Codes for tendon, muscle, or bone procedures (
01472,01474,01484,01486) are used for specific surgical interventions and are not commonly billed with01464.
National Reimbursement Benchmarks
National mean rates for CPT code 01464 show that Blue Cross Blue Shield, Aetna, and Cigna all reimburse at similar levels, with Cigna slightly higher at $198.38. UnitedHealth Group is notably lower, with a mean rate of $65.51. The BUCA average commercial rate stands at $123.76, which is significantly higher than UnitedHealth Group but below the other major commercial payers. Medicare rates are not available in the input.
Rate dispersion varies across payers. UnitedHealth Group has the tightest range between the 25th and 75th percentiles ($24.75), indicating less variability in reimbursement. In contrast, Aetna and Cigna show the widest dispersion, with ranges of $220.50 and $172.67 respectively, reflecting greater variability in contracted rates. 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 range in reimbursement rates for CPT code 01464, with Blue Cross Blue Shield showing the largest spread between the 25th and 75th percentiles ($91.47), indicating significant variability in payments. In contrast, Aetna and UnitedHealth Group have minimal rate spreads, with all percentiles clustered at $72.00 or slightly above, suggesting consistent but lower payment levels. Cigna's rates are also tightly grouped, with only an $8.00 difference between the 25th and 75th percentiles.
Compared to national averages, Blue Cross Blue Shield and Aetna both offer higher mean rates in Alaska, while Cigna and UnitedHealth Group are below their respective national means. The table and chart below present the full breakdown of payer-specific reimbursement benchmarks for Alaska.
Key Insights for Alaska
- Blue Cross Blue Shield offers the highest mean reimbursement rate for CPT 01464 in Alaska at $219.34, while UnitedHealth Group is the lowest at $74.78.
- Cigna's mean rate in Alaska ($89.33) is significantly below its national average ($198.38), indicating a notable deviation.
- The rate spread for Blue Cross Blue Shield (75th minus 25th percentile) is substantial at $91.47, reflecting considerable variability in payments.
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