Summary & Overview
CPT 01935: Anesthesia for Percutaneous Image-Guided Spine Diagnostic Procedures
CPT code 01935 represents anesthesia for percutaneous image-guided diagnostic procedures on the spine and spinal cord. This code is significant nationally as it supports minimally invasive diagnostic interventions, which are increasingly common in pain management and neurology. The code is primarily utilized in outpatient hospital settings, reflecting the shift toward ambulatory care for spinal diagnostics.
Key payers covered in this analysis include Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Understanding coverage and reimbursement policies for these major insurers is essential for providers and administrators navigating the evolving landscape of anesthesiology services.
Readers will gain insights into clinical benchmarks, policy updates, and the broader context of anesthesia billing for spinal diagnostic procedures. The publication also addresses relevant modifiers, associated taxonomies, and related CPT codes, providing a comprehensive overview for stakeholders in anesthesiology, pain medicine, and radiation oncology. This summary offers a clear perspective on how CPT 01935 fits within current clinical and billing practices, supporting informed decision-making across the healthcare sector.
CPT Code Overview
CPT 01935 is used to report anesthesia services for percutaneous image-guided procedures on the spine and spinal cord when performed for diagnostic purposes. This code falls under the anesthesiology service type and is typically provided in an outpatient hospital setting (Place of Service 22). The procedure involves the administration of anesthesia to support minimally invasive diagnostic interventions on the spinal region, ensuring patient comfort and safety during image-guided evaluations.
Clinical & Coding Specifications
Clinical Context
A patient presents to the outpatient hospital with persistent low back pain, cervicalgia, or thoracic spine pain that has not responded to conservative management. The physician determines that a percutaneous, image-guided diagnostic procedure on the spine or spinal cord is indicated to further evaluate the source of pain. An anesthesiologist or pain medicine physician provides anesthesia services during the procedure to ensure patient comfort and safety. The procedure is performed under monitored anesthesia care, and the patient is typically healthy (ASA Physical Status P1).
Coding Specifications
-
Modifier
QS: Indicates that monitored anesthesia care (MAC) was provided during the procedure. Used when the anesthesiologist is present and monitoring the patient throughout. -
Modifier
P1: Denotes that the patient is a normal, healthy individual (ASA Physical Status 1).
| Provider Taxonomy Code | Specialty Name |
|---|---|
207L00000X | Anesthesiology |
207LP2900X | Pain Medicine Physician |
207RA0000X | Radiation Oncology Physician |
- Anesthesiology: Physicians specializing in anesthesia administration and perioperative care.
- Pain Medicine Physician: Specialists in pain management, often involved in spine procedures.
- Radiation Oncology Physician: May be involved in image-guided procedures related to the spine.
Related Diagnoses
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M54.5- Low back pain- Relevant for patients undergoing diagnostic spine procedures to evaluate persistent lumbar pain.
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M54.2- Cervicalgia- Indicates neck pain, which may necessitate diagnostic procedures on the cervical spine.
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M54.6- Pain in thoracic spine- Used for patients with thoracic spine pain requiring further diagnostic evaluation.
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M54.9- Dorsalgia, unspecified- Applies to patients with unspecified back pain, supporting the need for diagnostic investigation.
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G89.29- Other chronic pain- Used for patients with chronic pain not otherwise specified, justifying diagnostic spine procedures.
Related CPT Codes
| CPT Code | Description |
|---|---|
77003 | Fluoroscopic guidance for needle placement |
62323 | Injection(s), of diagnostic or therapeutic substance(s) |
64483 | Injection(s) for nerve block, lumbar or sacral |
01936 | Anesthesia for percutaneous image guided procedures on the spine; therapeutic |
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77003: Used for imaging guidance during needle placement, often performed concurrently with the diagnostic spine procedure. -
62323: Represents injection of diagnostic or therapeutic substances into the spine, which may be the primary procedure for which anesthesia is provided. -
64483: Refers to nerve block injections in the lumbar or sacral region, which may be performed as part of pain management and require anesthesia. -
01936: Anesthesia for therapeutic percutaneous image-guided spine procedures; used as an alternative to01935when the procedure is therapeutic rather than diagnostic.
National Reimbursement Benchmarks
National mean rates for CPT code 01935 show that Blue Cross Blue Shield and BUCA (average commercial) payers have mean rates of $169.62 and $158.10, respectively. Cigna stands out with a significantly higher mean rate of $746.94, while UnitedHealth Group is notably lower at $79.60. Medicare data is not available in the input for comparison.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Cigna has the widest range at $230.00, indicating substantial variability in rates. Blue Cross Blue Shield and BUCA both have a range of $218.00, while UnitedHealth Group has the tightest spread at $49.00. This suggests that UnitedHealth Group's rates are more consistent nationally, whereas Cigna's rates are more variable.
The table and chart below present the full breakdown of national benchmarks for CPT code 01935 by payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska shows a wide rate spread for CPT code 01935, with Blue Cross Blue Shield's 75th percentile ($475.00) and 25th percentile ($371.50) indicating a spread of $103.50. Cigna's rates are consistent across all percentiles, while UnitedHealth Group displays a much lower and narrower spread ($65.00 at the 75th percentile and $58.00 at the 25th percentile, a difference of $7.00). Compared to national averages, both Blue Cross Blue Shield and Cigna in Alaska reimburse at much higher rates, while UnitedHealth Group is below its national mean.
The table and chart below present the full breakdown of mean rates and percentiles for each payer in Alaska, highlighting the significant variation in reimbursement levels across payers.
Key Insights for Alaska
- Cigna is the highest paying payer for CPT 01935 in Alaska, with a mean rate of $474.50.
- UnitedHealth Group is the lowest paying payer, with a mean rate of $69.87, significantly below both state and national averages.
- Blue Cross Blue Shield and Cigna rates in Alaska are substantially higher than their respective national averages, while UnitedHealth Group's rate is lower than its national mean.
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