Summary & Overview
CPT 01712: Anesthesia for Upper Arm and Elbow Procedures
CPT code 01712 represents anesthesia for procedures on the upper arm and elbow, including interventions like open tenotomy. This code is significant for hospitals and anesthesia providers nationwide, as it ensures proper billing and reimbursement for anesthesia services during upper extremity surgeries. The publication covers key payers such as Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, providing a comprehensive overview of payer coverage and policy considerations.
Readers will gain insights into clinical benchmarks, policy updates, and the billing context for anesthesia services related to upper arm and elbow procedures. The summary includes information on typical sites of service, common modifiers, and associated provider taxonomies. Additionally, relevant ICD-10 diagnoses and related CPT codes are discussed to provide a broader clinical and billing context. This resource is designed to support healthcare professionals, administrators, and policy analysts in understanding the national landscape for anesthesia billing under CPT code 01712.
CPT Code Overview
CPT code 01712 is used to report anesthesia services for procedures performed on the upper arm and elbow, such as open tenotomy. 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 upper extremity surgical interventions.
Clinical & Coding Specifications
Clinical Context
A patient presents to the outpatient hospital with persistent pain or injury involving the upper arm or elbow, such as a tendon injury requiring an open tenotomy. The clinical workflow involves preoperative assessment by the anesthesiology team, followed by administration of anesthesia for the surgical procedure on the upper arm or elbow. The anesthesia is provided by an anesthesiology physician, certified registered nurse anesthetist, or anesthesiology assistant, depending on staffing and patient needs. The procedure is typically performed in an outpatient setting, and anesthesia services are documented and coded accordingly.
Coding Specifications
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Modifiers:
QS: Monitored anesthesia care service. Used when the anesthesia provider delivers monitored anesthesia care rather than general anesthesia.QX: CRNA service with medical direction by a physician. Used when a certified registered nurse anesthetist provides anesthesia under the medical direction of a physician.
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Provider Taxonomies:
Taxonomy Code Specialty Name 207L00000XAnesthesiology Physician 367500000XCertified Registered Nurse Anesthetist 207RA0401XAnesthesiology Assistant
Related Diagnoses
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M25.571: Pain in right ankle and joints of right foot- Relevant for patients experiencing pain in the lower extremity, though not directly related to upper arm/elbow procedures.
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M25.572: Pain in left ankle and joints of left foot- Indicates pain in the left lower extremity, not directly associated with upper arm/elbow procedures.
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M79.671: Pain in right foot- Represents localized pain in the right foot, which may be considered in differential diagnosis but is not directly related to upper arm/elbow anesthesia.
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M79.672: Pain in left foot- Indicates pain in the left foot, not directly relevant to upper arm/elbow procedures.
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S93.401A: Sprain of unspecified ligament of right ankle, initial encounter- Represents an acute injury to the right ankle, which is not directly associated with upper arm/elbow procedures but may be relevant in cases where multiple injuries are present.
Related CPT Codes
| CPT Code | Description |
|---|---|
01462 | Anesthesia for procedures on lower leg, knee joint |
01464 | Anesthesia for open or surgical arthroscopic procedures on knee joint |
01470 | Anesthesia for procedures on bones of lower leg, ankle, and foot |
01480 | Anesthesia for procedures on nerves, muscles, tendons, fascia, and bursae of knee and popliteal area |
01462,01464,01470, and01480are related to01712as they represent anesthesia services for procedures on adjacent or anatomically related areas of the lower extremity. These codes may be used as alternatives when the surgical site is on the lower leg, knee, ankle, or foot rather than the upper arm or elbow. They are not typically used together with01712in the same encounter, but may be selected based on the specific location of the procedure.
National Reimbursement Benchmarks
Nationally, the mean rate for CPT code 01712 among commercial payers (BUCA) is $148.41, which is more than double the UnitedHealth Group mean rate of $65.48. Blue Cross Blue Shield and Cigna have the highest mean rates at $263.29 and $298.29, respectively, while Aetna's mean rate is $206.73.
Rate dispersion varies significantly across payers. UnitedHealth Group shows the tightest range, with a difference of $25.00 between the 75th and 25th percentiles. In contrast, Aetna and Cigna exhibit much wider ranges, with Aetna's dispersion at $324.00 and Cigna's at $345.00, indicating greater variability in rates. Blue Cross Blue Shield and BUCA also show moderate dispersion, at $140.47 and $171.83, respectively.
The table and chart below present a detailed breakdown of national mean rates and percentile values for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska shows a wide spread in reimbursement rates for CPT code 01712, particularly with Blue Cross Blue Shield, where the 75th percentile ($370.00) is $95.40 higher than the 25th percentile ($274.60). Aetna, Cigna, and UnitedHealth Group display much narrower spreads, with their 25th, 50th, and 75th percentiles clustered closely together, indicating limited rate variation. Compared to national averages, Blue Cross Blue Shield and Aetna in Alaska pay notably higher mean rates, while Cigna and UnitedHealth Group are well below their respective national means.
The table and chart below present the full breakdown of payer-specific reimbursement rates for CPT code 01712 in Alaska, highlighting the differences in mean and percentile values across the major commercial payers.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 01712 in Alaska, with a mean rate of $327.81.
- UnitedHealth Group offers the lowest mean rate at $74.78, significantly below both state and national averages.
- Cigna's mean rate in Alaska ($89.33) is much lower than its national mean ($298.29), indicating a substantial deviation.
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.