Summary & Overview
CPT 01620: Anesthesia for Knee and Popliteal Area Procedures
CPT code 01620 represents anesthesia for procedures on the knee and/or popliteal area that are not otherwise specified. This code is significant for hospitals and anesthesia providers, as it covers a broad range of knee interventions where specific anesthesia codes do not apply. Nationally, the code is recognized by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, making it relevant for providers seeking coverage and reimbursement across diverse patient populations.
The publication provides a comprehensive overview of CPT 01620, including payer coverage, typical clinical scenarios, and associated billing practices. Readers will gain insights into benchmarks for utilization, policy updates affecting anesthesia services, and the clinical context in which this code is applied. The analysis also highlights common modifiers used in conjunction with this code, relevant provider taxonomies, and associated ICD-10 diagnoses that frequently justify its use. Additionally, related CPT codes are discussed to clarify distinctions and support accurate coding.
This summary equips healthcare professionals, billing specialists, and policy analysts with the information needed to understand the scope and application of CPT 01620 in outpatient hospital settings, supporting compliance and operational efficiency.
CPT Code Overview
CPT 01620 is used to report anesthesia services for procedures performed on the knee and/or popliteal area that are not otherwise specified. This code falls under the anesthesiology service type and is most commonly utilized in the outpatient hospital setting (Place of Service 22). The code is essential for accurately documenting and billing anesthesia care provided during a range of knee-related procedures, ensuring proper reimbursement and compliance with national standards.
Clinical & Coding Specifications
Clinical Context
A patient presents to the outpatient hospital with knee pain and functional limitation due to a condition such as unilateral primary osteoarthritis or chronic instability. The orthopedic surgeon schedules a procedure on the knee or popliteal area that does not fall under a more specific anesthesia code. The anesthesiology team evaluates the patient preoperatively, confirms the need for anesthesia, and provides anesthesia services during the procedure. The anesthesia may be administered by a physician anesthesiologist, a certified registered nurse anesthetist (CRNA), or an anesthesiology assistant, depending on staffing and medical direction. The procedure is performed in an outpatient hospital setting (Place of Service 22), and anesthesia is monitored throughout the surgical intervention. Documentation includes the anesthesia start and stop times, the type of anesthesia provided, and any relevant modifiers indicating the nature of the service or provider involvement.
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) rather than general anesthesia. -
QX: CRNA service with medical direction by a physician. Used when a CRNA provides anesthesia services under the medical direction of a physician anesthesiologist.
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Provider Taxonomies:
Taxonomy Code Specialty Name 207L00000XAnesthesiology 367500000XCertified Registered Nurse Anesthetist (CRNA) 207RA0401XAnesthesiology Assistant -
Specialties Represented:
- Anesthesiology
- Certified Registered Nurse Anesthetist
- Anesthesiology Assistant
Related Diagnoses
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M17.11: Unilateral primary osteoarthritis, right knee- Indicates degenerative changes in the right knee, often leading to surgical intervention requiring anesthesia.
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M17.12: Unilateral primary osteoarthritis, left knee- Represents osteoarthritis in the left knee, commonly necessitating procedures with anesthesia.
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S83.241A: Sprain of medial collateral ligament of right knee, initial encounter- Acute injury to the right knee's medial collateral ligament, may require surgical repair or intervention with anesthesia.
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S83.242A: Sprain of medial collateral ligament of left knee, initial encounter- Acute injury to the left knee's medial collateral ligament, relevant for procedures needing anesthesia.
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M23.50: Chronic instability of knee, unspecified knee- Chronic instability may lead to surgical procedures on the knee or popliteal area, requiring anesthesia services.
Related CPT Codes
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01400: Anesthesia for open or surgical arthroscopic procedures on knee joint. This code is used for more specific knee procedures, such as open or arthroscopic surgery, and may be selected instead of01620when the procedure details match. -
29881: Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving). This is a surgical procedure on the knee that may require anesthesia services billed under01620or01400, depending on the specifics. -
29888: Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction. This procedure involves ACL repair and typically requires anesthesia, with01620or01400used for anesthesia coding. -
20610: Arthrocentesis, aspiration and/or injection into a major joint or bursa. This is a less invasive procedure that may require anesthesia, especially in patients with significant pain or anxiety, and01620may be used for anesthesia services.
Clinical Workflow Relation:
01400is an alternative to01620for more specific knee procedures.29881and29888are surgical procedures that may be performed with anesthesia services billed under01620.20610may be performed with anesthesia in select cases, using01620.
National Reimbursement Benchmarks
National mean rates for CPT code 01620 show that Cigna and Blue Cross Blue Shield have the highest average reimbursement, at $248.87 and $215.62 respectively. UnitedHealth Group is notably lower, with a mean rate of $65.52. The BUCA (average commercial) mean rate stands at $119.48, which is significantly higher than typical Medicare rates, though Medicare data is not available in the input for this code.
Rate dispersion varies considerably across payers. Blue Cross Blue Shield has the tightest spread, with a difference of $102.78 between its 75th and 25th percentiles, indicating more consistent rates. Cigna shows the widest dispersion, with a $258.00 gap, reflecting greater variability in reimbursement. UnitedHealth Group and BUCA also have relatively narrow ranges, at $24.80 and $125.49 respectively.
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 substantial rate spread for CPT code 01620 across commercial payers. Blue Cross Blue Shield shows the widest spread, with a 75th percentile rate of $298.50 and a 25th percentile rate of $225.80, resulting in a $72.70 difference. BUCA also exhibits a notable spread of $135.78 between its 75th and 25th percentiles. In contrast, Aetna and UnitedHealth Group have minimal spreads, with all percentile values clustered closely around $72.00–$75.00, indicating limited rate variability.
Compared to national averages, Alaska's mean rates for most payers are significantly higher, particularly for Blue Cross Blue Shield and BUCA. The table and chart below present the full breakdown of payer-specific reimbursement rates in Alaska, highlighting these differences and the range of payment levels across the state.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 01620 in Alaska, with a mean rate of $267.01.
- 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.