Summary & Overview
CPT 01961: Anesthesia for Cesarean Delivery Only
Headline: CPT 01961: Anesthesia for Cesarean Delivery Only — Clinical and Payer Overview
CPT 01961 represents anesthesia services provided specifically for cesarean delivery procedures. This code is important nationally because cesarean delivery is a common obstetric procedure, and accurate coding for anesthesia influences clinical documentation, billing integrity, and resource allocation across hospital settings. The code applies to anesthetic management during cesarean delivery when the anesthesia is limited to the operation itself.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will find an overview of payer coverage considerations and common clinical contexts in which 01961 is used, including typical ICD-10 diagnoses associated with cesarean delivery events. The publication also outlines related CPT codes for other obstetric anesthesia scenarios to clarify code selection and sequencing for cases such as vaginal delivery, neuraxial labor analgesia, and cesarean delivery following neuraxial labor anesthesia.
This summary equips billing professionals, anesthesiologists, and hospital administrators with concise clinical context, common coding adjacencies, and the payer landscape relevant to 01961. Data not available in the input for detailed service-line benchmarking and specific payer policy language is noted where applicable. The piece is organized to provide immediate guidance on code purpose, clinical applicability, and where to look next for payer-specific rules and modifier use.
CPT Code Overview
CPT 01961 describes anesthesia for cesarean delivery only. This procedure falls under the Anesthesiology service line and is typically performed in a hospital inpatient setting, such as an operating room (Place of Service 21). The code designates the anesthesia services provided specifically for cesarean delivery procedures and is used to document and bill for anesthetic management associated with a cesarean section.
Clinical & Coding Specifications
Clinical Context
A 32-year-old gravida 2 para 1 patient at term is scheduled for a planned cesarean delivery due to a prior low transverse uterine scar. The patient is admitted to the hospital operating room (POS 21) on the day of delivery. Preoperative evaluation by the anesthesia team documents maternal vital signs, airway assessment, relevant obstetric history, and consent for neuraxial or general anesthesia. Neuraxial anesthesia (spinal or combined spinal-epidural) is typically established before the cesarean incision unless contraindicated. Intraoperative monitoring includes continuous maternal hemodynamics and fetal considerations as appropriate. Postoperative handoff is provided to the recovery or postpartum unit with anesthesia documentation of drugs, doses, technique, and any airway or hemodynamic events. The anesthesia service provided for the cesarean delivery is billed under 01961 for anesthesia for cesarean delivery only.
Coding Specifications
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Common Modifiers
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AA: Anesthesia services performed personally by an anesthesiologist. Use when the physician anesthesiologist personally provides the anesthesia care for01961. -
QK: Medical direction of two, three, or four concurrent anesthesia procedures. Use when an anesthesiologist medically directs multiple concurrent anesthesia providers and meets reporting criteria for directing 2–4 cases while01961is one of those services. -
QX: CRNA service with medical direction by a physician. Use when a Certified Registered Nurse Anesthetist furnishes the anesthesia for01961under the medical direction of a physician and the encounter meets supervision and documentation requirements. -
QY: Medical direction of one CRNA by an anesthesiologist. Use when the anesthesiologist directs one CRNA for the anesthetic for01961and documentation supports medical direction of a single CRNA. -
Provider Taxonomies
| Taxonomy Code | Specialty |
|---|---|
207L00000X | Anesthesiology Physician |
367500000X | Certified Registered Nurse Anesthetist |
207LA0401X | Pediatric Anesthesiology Physician |
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Notes on use
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Use the modifier that accurately reflects who performed or directed the anesthesia care for
01961and ensure documentation supports the choice. -
The listed taxonomies identify provider types eligible to furnish anesthesia services associated with
01961.
Related Diagnoses
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O82— Encounter for cesarean delivery without indication- Relevant because this code describes the encounter for the surgical delivery for which anesthesia is provided under
01961.
- Relevant because this code describes the encounter for the surgical delivery for which anesthesia is provided under
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O34.211— Maternal care for low transverse scar from previous cesarean delivery- Relevant because a history of prior cesarean scar commonly leads to planned repeat cesarean delivery requiring anesthesia services billed as
01961.
- Relevant because a history of prior cesarean scar commonly leads to planned repeat cesarean delivery requiring anesthesia services billed as
-
O66.5— Failed trial of labor after previous cesarean delivery- Relevant because a failed trial of labor often results in urgent cesarean delivery where
01961is used to report the anesthesia for the cesarean procedure.
- Relevant because a failed trial of labor often results in urgent cesarean delivery where
-
O75.82— Maternal exhaustion complicating labor and delivery- Relevant because maternal exhaustion may precipitate operative delivery by cesarean, necessitating anesthesia services reported with
01961.
- Relevant because maternal exhaustion may precipitate operative delivery by cesarean, necessitating anesthesia services reported with
-
O80— Encounter for full-term uncomplicated delivery- Relevant as a general delivery encounter code; when a cesarean delivery occurs in a term pregnancy, anesthesia care for the cesarean is reported with
01961.
- Relevant as a general delivery encounter code; when a cesarean delivery occurs in a term pregnancy, anesthesia care for the cesarean is reported with
Related CPT Codes
| CPT Code | Description | Relationship to 01961 |
|---|---|---|
01960 | Anesthesia for vaginal delivery only | Alternative anesthesia code for vaginal delivery; not used when cesarean delivery anesthesia is provided under 01961. |
01967 | Neuraxial labor analgesia/anesthesia for planned vaginal delivery | Represents neuraxial labor analgesia for planned vaginal delivery; may precede or be an alternative pathway to cesarean anesthesia depending on clinical course. |
01968 | Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia | Used when a patient who received neuraxial labor analgesia requires conversion to cesarean delivery anesthesia; commonly used instead of 01961 when labor epidural/analgesia is converted. |
01969 | Anesthesia for cesarean hysterectomy after neuraxial anesthesia | Used when cesarean delivery progresses to hysterectomy after neuraxial anesthesia; represents a more extensive intraoperative procedure relative to 01961. |
- Codes
01968and01969are commonly used together in clinical workflows where labor analgesia is already in place and the surgical plan escalates;01961is used for cesarean delivery anesthesia when neuraxial labor analgesia was not the preceding anesthetic pathway.
National Reimbursement Benchmarks
National mean rates show a notable gap between Medicare and BUCA (average commercial). Medicare’s mean rate is not provided in the input (reported here as $0.00 for completeness), while BUCA’s mean rate is $257.20, indicating that average commercial payments are substantially higher than the absent Medicare benchmark in this dataset.
Rate dispersion, measured as the difference between the 75th and 25th percentiles, varies across payers. Cigna exhibits the widest dispersion (P75 − P25 = $664.80), reflecting broad variability in contracted rates. Aetna also shows a wide spread (P75 − P25 = $594.00). UnitedHealth Group is the tightest (P75 − P25 = $25.33), indicating relatively consistent rates. The table and chart below present the full percentile and mean breakdown for the national benchmarks.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska shows a wide spread in reimbursement rates for CPT code 01961 across commercial payers. The rate spread, calculated as the difference between the 75th and 25th percentiles, is most pronounced for Blue Cross Blue Shield ($239.25) and BUCA ($271.33), indicating significant variability in negotiated rates. In contrast, Aetna and UnitedHealth Group have minimal spreads, suggesting more uniform payment structures. Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and BUCA are higher, while Cigna and UnitedHealth Group are notably lower than their respective national means.
The table and chart below present the full breakdown of mean rates and percentile values for each payer in Alaska. This detailed comparison highlights the substantial differences in reimbursement levels among payers within the state.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 01961 in Alaska, with a mean rate of $481.25.
- 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 ($509.81), 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.