Summary & Overview
CPT 01960: Anesthesia for Vaginal Delivery
CPT 01960 represents anesthesia services furnished for vaginal delivery and is a key obstetric anesthesia code used across inpatient hospital settings nationally. It matters because anesthesia management during vaginal birth affects clinical outcomes, resource utilization, and hospital billing workflows for labor and delivery services. Common stakeholders include anesthesiologists, certified registered nurse anesthetists, obstetric teams, and hospital billing departments.
Major payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will find a concise overview of the clinical context for CPT 01960, how it is positioned among related obstetric anesthesia codes, and the common billing modifiers used with this service. The publication outlines typical sites of service and associated clinical diagnoses relevant to obstetric anesthesia, and it highlights related procedure codes for external cephalic version, cesarean delivery, and urgent hysterectomy following delivery.
The content provides practical policy and billing context: reimbursement considerations tied to anesthesia delivery during vaginal birth, documentation elements that commonly accompany obstetric anesthesia claims, and references to associated clinical scenarios such as spontaneous and complicated deliveries. Data gaps are noted where input was not provided. This serves as a national reference for payers, clinicians, and revenue cycle stakeholders seeking a succinct briefing on CPT 01960.
CPT Code Overview
CPT 01960 describes anesthesia provided for obstetric procedures specifically for vaginal delivery. This service falls under Anesthesiology – Obstetric Procedures and is typically delivered in an Inpatient Hospital (POS 21) setting. The code denotes the anesthesia care component associated with managing pain and physiological stability for patients undergoing vaginal delivery.
Clinical & Coding Specifications
Clinical Context
A 28-year-old G1P0 patient is admitted to the inpatient hospital labor and delivery unit in active labor for a planned vaginal delivery. Maternal monitoring and fetal heart rate tracing are performed; obstetric and anesthesia teams coordinate for analgesia and anesthesia management during labor and delivery. An anesthesiologist or CRNA provides neuraxial anesthesia (epidural or spinal) or general anesthesia when clinically indicated for vaginal delivery under the anesthesia service described by 01960. Typical workflow includes pre-anesthesia evaluation, consent, placement of neuraxial blockade, intra-partum management of pain and hemodynamics, and post-delivery handoff for postpartum monitoring and documentation.
Coding Specifications
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Common Modifiers
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AA— Anesthesia services performed personally by an anesthesiologist. Use when the named anesthesiologist personally furnishes the anesthesia. -
QK— Medical direction of two, three, or four concurrent anesthesia procedures. Use when the physician medically directs multiple concurrent anesthesia providers (CRNAs) for up to four cases. -
QX— CRNA service with medical direction by a physician. Use when the CRNA performs the anesthesia service and a physician provides medical direction. -
QY— Medical direction of one CRNA by an anesthesiologist. Use when the anesthesiologist medically directs a single CRNA. -
Associated Provider Taxonomies
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207L00000X— Anesthesiology (specialty providing anesthesia services, including neuraxial and general anesthesia management). -
367500000X— Certified Registered Nurse Anesthetist (CRNA) (advanced practice nurse providing anesthesia services under supervision or direction). -
207V00000X— Obstetrics & Gynecology (obstetricians managing labor, delivery, and maternal-fetal care).
Related Diagnoses
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O80— Encounter for full-term uncomplicated deliveryClinical relevance: This represents a routine full-term vaginal delivery, the typical indication for anesthesia services described by
01960when neuraxial analgesia or anesthesia is provided for labor and delivery management. -
O82— Encounter for cesarean delivery without indicationClinical relevance: This code denotes a cesarean delivery. It is a related obstetric diagnosis but typically corresponds to anesthesia code
01961rather than01960when a surgical delivery occurs. -
O60.1— Preterm labor with preterm deliveryClinical relevance: Preterm labor resulting in preterm vaginal delivery may require anesthesia management covered by
01960if neuraxial or general anesthesia is provided for the delivery. -
O70.1— Second degree perineal laceration during deliveryClinical relevance: Perineal lacerations occurring with vaginal delivery represent common obstetric outcomes; anesthesia services under
01960may be provided during repair or management related to the vaginal delivery. -
O62.0— Primary inadequate contractionsClinical relevance: Dysfunctional labor due to inadequate contractions may prolong labor or prompt interventions; anesthesia services described by
01960are applicable when analgesia or anesthesia is provided during the vaginal delivery process.
Related CPT Codes
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01958— Anesthesia for Obstetric Procedures: external cephalic version procedure.Clinical relation:
01958is used for anesthesia provided during an external cephalic version, a procedure to attempt to turn a breech fetus to cephalic presentation. It is a different obstetric anesthesia service than01960and is used for a specific procedure rather than routine vaginal delivery. It is an alternative service in the obstetric anesthesia family. -
01961— Anesthesia for Obstetric Procedures: cesarean delivery.Clinical relation:
01961applies to anesthesia for cesarean delivery and is used when a surgical delivery is performed instead of a vaginal delivery. In workflows where a planned vaginal delivery converts to cesarean delivery,01961would replace01960for the cesarean portion of care. -
01962— Anesthesia for Obstetric Procedures: urgent hysterectomy following delivery.Clinical relation:
01962is used for anesthesia provided for an urgent hysterectomy following delivery (for example, for uncontrolled postpartum hemorrhage). It is used in emergent extensions of obstetric care and may follow or supersede01960if hysterectomy becomes necessary.
National Reimbursement Benchmarks
Nationally, Medicare mean rates are substantially lower than the BUCA (average commercial) mean: Medicare is effectively at $0.00 in the provided input versus BUCA at $185.95. Commercial payers such as Cigna and Blue Cross Blue Shield report the highest mean rates nationally, while UnitedHealth Group reports a much lower mean.
Dispersion (P75 minus P25) varies notably across payers. Blue Cross Blue Shield and Cigna show the widest dispersion (BCBS: $392.26; Cigna: $501.25), indicating broad variability in paid rates. Aetna and BUCA show moderate dispersion (Aetna: $308.00; BUCA: $207.67). UnitedHealth Group is the tightest (UHC: $25.25), reflecting more clustered rates. The table and chart below present the full percentile and mean-rate breakdown for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska's reimbursement rates for CPT code 01960 show considerable variation across commercial payers. The rate spread, calculated as the difference between the 75th and 25th percentiles, is most pronounced for Blue Cross Blue Shield at $96.73, while Aetna, Cigna, and UnitedHealth Group exhibit much narrower spreads, all under $21.00. Compared to national averages, Blue Cross Blue Shield's mean rate in Alaska is lower than its national benchmark, while Cigna and UnitedHealth Group are significantly below their respective national means. Aetna's mean rate in Alaska is slightly above its national average.
The table and chart below present the full breakdown of mean rates and percentile values for each payer in Alaska, highlighting the differences in reimbursement levels and variability across the market.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 01960 in Alaska, with a mean rate of $328.21, while UnitedHealth Group is the lowest at $74.78.
- The rate spread is widest for Blue Cross Blue Shield, with a difference of $96.73 between the 75th and 25th percentiles, indicating significant variability.
- Cigna and UnitedHealth Group mean rates in Alaska are notably lower than their respective national averages, while Blue Cross Blue Shield's mean rate is below its national benchmark.
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