Summary & Overview
CPT 01654: Anesthesia for Lower Leg Procedures, Not Otherwise Specified
CPT code 01654 represents anesthesia for procedures on the lower leg, below the knee, not otherwise specified. This code is significant for hospitals and anesthesia providers nationwide, as it ensures proper billing and documentation for a variety of lower leg surgical interventions. The code is most frequently used in outpatient hospital settings, reflecting the trend toward ambulatory surgical care.
Major national payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Understanding payer policies and coverage for CPT code 01654 is crucial for providers and billing teams to maintain compliance and optimize reimbursement.
This publication offers a comprehensive overview of CPT code 01654, including its clinical context, typical site of service, and related coding benchmarks. Readers will gain insights into payer coverage, policy updates, and the role of anesthesia in lower leg procedures. The summary also highlights common modifiers and associated taxonomies relevant to anesthesiology, providing a clear framework for accurate coding and billing. By reviewing this information, stakeholders can stay informed about national trends and requirements for anesthesia services in lower leg procedures.
CPT Code Overview
CPT code 01654 is used to report anesthesia services for procedures performed on the lower leg, specifically below the knee, when the procedure is 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 lower leg procedures, 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 acute or chronic conditions affecting the lower leg, below the knee. Examples include a closed fracture of the upper end of the right tibia, pain or contracture in the right knee, unilateral primary osteoarthritis, or a sprain of the anterior cruciate ligament. The patient is scheduled for a surgical or diagnostic procedure on the lower leg, below the knee, requiring anesthesia services. An anesthesiologist, certified registered nurse anesthetist, or anesthesiology assistant provides anesthesia care, ensuring patient comfort and safety throughout the procedure. The workflow includes pre-anesthesia assessment, administration of anesthesia, intraoperative monitoring, and post-anesthesia recovery.
Coding Specifications
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Modifiers:
QS: Monitored anesthesia care service. Used when anesthesia is provided in a manner that allows the patient to remain responsive and breathing independently.QX: CRNA service with medical direction by a physician. Used when a certified registered nurse anesthetist provides anesthesia under the supervision of a physician.
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Provider Taxonomies:
Code Specialty Name 207L00000XAnesthesiology 367500000XCertified Registered Nurse Anesthetist 207RA0401XAnesthesiology Assistant
These taxonomies represent the specialties eligible to provide anesthesia services for procedures on the lower leg, below the knee.
Related Diagnoses
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S82.101A: Fracture of upper end of right tibia, initial encounter for closed fracture- Relevant for anesthesia during surgical repair or management of tibial fractures below the knee.
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M25.561: Pain in right knee- Indicates the need for anesthesia during procedures addressing knee pain, such as injections or arthroscopy.
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M17.11: Unilateral primary osteoarthritis, right knee- Common diagnosis for patients undergoing procedures to manage osteoarthritis, including surgical interventions below the knee.
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S83.511A: Sprain of anterior cruciate ligament of right knee, initial encounter- Relevant for anesthesia during surgical or diagnostic procedures for ligament injuries below the knee.
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M24.561: Contracture, right knee- Indicates procedures to address joint contracture, often requiring anesthesia for patient comfort and safety.
Related CPT Codes
01402: Anesthesia for open or surgical arthroscopic procedures on knee joint. Used when the procedure involves the knee joint specifically, often in cases of surgical intervention.01444: Anesthesia for procedures on knee joint; total knee arthroplasty. Used for anesthesia during total knee replacement surgeries.20610: Arthrocentesis, aspiration and/or injection into a major joint or bursa. May be performed for diagnostic or therapeutic purposes, sometimes requiring anesthesia for patient comfort.29881: Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving). Surgical procedure on the knee joint, often requiring anesthesia services.
These codes are related to 01654 as they represent procedures on or around the knee and lower leg. 01402 and 01444 are commonly used as alternatives when the procedure is specifically on the knee joint. 20610 and 29881 may be performed in conjunction with anesthesia services, depending on the clinical scenario.
National Reimbursement Benchmarks
National mean rates for CPT code 01654 show significant variation across commercial payers. Cigna has the highest mean rate at $454.82, followed by Blue Cross Blue Shield at $374.99, while UnitedHealth Group is notably lower at $65.63. The BUCA average commercial mean rate stands at $174.43. 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 Cigna ($603.79) and Aetna ($410.00), indicating substantial variability in contracted rates. Blue Cross Blue Shield ($208.12) and BUCA ($220.00) show moderate dispersion, while UnitedHealth Group has the tightest range at $25.17, reflecting more consistent rates.
The table and chart below present the full breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a wide range in reimbursement rates for CPT code 01654, with Blue Cross Blue Shield offering the highest mean rate at $509.76 and UnitedHealth Group the lowest at $74.78. The rate spread is particularly notable for Blue Cross Blue Shield, where the difference between the 75th and 25th percentiles ($583.75 minus $420.60) is $163.15, indicating significant variability. In contrast, Aetna, Cigna, and UnitedHealth Group show minimal spread, with their 25th, 50th, and 75th percentiles tightly grouped around $72–$93.
Compared to national benchmarks, Alaska's mean rates for Blue Cross Blue Shield and BUCA are considerably higher, while Cigna and UnitedHealth Group are below their respective national averages. The table and chart below present the full breakdown of payer-specific rates in Alaska, highlighting these disparities and the overall landscape for CPT code 01654.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 01654 in Alaska, with a mean rate of $509.76, while UnitedHealth Group is the lowest at $74.78.
- The rate spread is substantial, with BCBS's 75th percentile ($583.75) far exceeding Aetna, Cigna, and UnitedHealth Group, whose 75th percentiles cluster around $72–$93.
- Compared to national averages, BCBS and BUCA pay significantly more in Alaska, while Cigna and UnitedHealth Group pay less than their national mean rates.
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