Summary & Overview

CPT 01200: Anesthesia for Upper Leg Procedures (Except Knee)

CPT code 01200 covers anesthesia for procedures performed on the upper leg, excluding the knee, and is a critical component in surgical care across a variety of clinical settings. This code is widely recognized and utilized by anesthesiology professionals to ensure patient safety and comfort during upper leg surgeries. Nationally, the code is accepted by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, reflecting its broad applicability and importance in medical billing and reimbursement.

Readers will gain insight into the clinical context of 01200, including its role in supporting surgical interventions on the upper leg. The publication provides an overview of payer coverage, common modifiers, and associated taxonomies, as well as relevant ICD-10 diagnoses that frequently accompany these procedures. Additionally, related CPT codes are highlighted to illustrate the range of anesthesia services for upper leg procedures. The summary offers benchmarks and policy updates relevant to anesthesiology billing, helping stakeholders understand the evolving landscape of anesthesia reimbursement and coding practices. This information is essential for healthcare administrators, billing professionals, and clinicians seeking to stay informed about anesthesia coding standards and payer requirements.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 01200anesthesiologyupper leg proceduresmedical billinganesthesia codingclinical benchmarkspolicy updatesICD-10 diagnosesprocedure reimbursementrelated CPT codes

CPT Code Overview

CPT code 01200 is designated for anesthesia services provided during procedures on the upper leg, excluding the knee. This code falls under the anesthesiology service type, which encompasses the administration and management of anesthesia to ensure patient comfort and safety during surgical interventions. The typical site of service for this code is unknown based on available data. This code is utilized by healthcare professionals specializing in anesthesiology to support a range of upper leg procedures, ensuring appropriate sedation and pain control throughout the operative process.

Clinical & Coding Specifications

Clinical Context

A patient presents for a surgical procedure involving the upper leg, excluding the knee. The clinical workflow typically involves preoperative assessment by an anesthesiologist, followed by administration of anesthesia for the procedure. The patient may have conditions such as muscle, tendon, or nerve injuries, or require arthroscopic intervention. The anesthesia is provided by a specialist in anesthesiology, pain medicine, or pediatric anesthesiology, depending on patient age and complexity. The procedure is performed in a hospital or ambulatory surgical center, with monitoring throughout the perioperative period.

Coding Specifications

Modifiers:
- QS: Monitored anesthesia care service. Used when the anesthesiologist provides monitored anesthesia care rather than general anesthesia.
- P1: A normal healthy patient. Indicates the patient has no systemic disease and is classified as ASA Physical Status 1.
Provider Taxonomies:

Taxonomy Code	Specialty Name
`207L00000X`	Anesthesiology
`207LA0401X`	Pain Medicine (Anesthesiology)
`207LP2900X`	Pediatric Anesthesiology

Specialties Represented:
- Anesthesiology: General anesthesia services.
- Pain Medicine (Anesthesiology): Focused on pain management during procedures.
- Pediatric Anesthesiology: Specialized care for pediatric patients undergoing anesthesia.

Related Diagnoses

M75.100: Unspecified rotator cuff tear or rupture of unspecified shoulder
- Relevant for patients with shoulder injuries requiring surgical intervention, potentially involving upper leg procedures if part of a multi-site operation.
S43.401A: Sprain of unspecified acromioclavicular joint, initial encounter
- Indicates acute shoulder injury; may be associated with trauma cases where multiple sites are addressed.
M19.011: Primary osteoarthritis, right shoulder
- Represents degenerative joint disease; relevant if the patient has comorbidities affecting surgical planning.
M19.012: Primary osteoarthritis, left shoulder
- Similar to M19.011, but affecting the left shoulder.
S42.001A: Fracture of unspecified part of right clavicle, initial encounter
- Indicates acute fracture; may be relevant in trauma cases requiring anesthesia for upper leg procedures as part of comprehensive care.

Related CPT Codes

01202: Under Anesthesia for Procedures on the Upper Leg (Except Knee) – arthroscopic procedure of the hip joint.
- Used when the procedure involves arthroscopy of the hip joint, requiring anesthesia services similar to 01200.
01250: Under Anesthesia for Procedures on the Upper Leg (Except Knee) – procedure on nerves, muscles, tendons, fascia, and bursae of the upper leg.
- Used for procedures targeting nerves, muscles, tendons, fascia, or bursae in the upper leg, which may require anesthesia services.

Clinical Relationship:

01202 and 01250 are related to 01200 as they all involve anesthesia for upper leg procedures, excluding the knee.
These codes may be used as alternatives depending on the specific surgical intervention performed.
It is uncommon to use these codes together for a single procedure; typically, one is selected based on the operative site and technique.

Summary & Overview

CPT 01200: Anesthesia for Upper Leg Procedures (Except Knee)

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifiers:
- QS: Monitored anesthesia care service. Used when the anesthesiologist provides monitored anesthesia care rather than general anesthesia.
- P1: A normal healthy patient. Indicates the patient has no systemic disease and is classified as ASA Physical Status 1.
Provider Taxonomies:

Taxonomy Code	Specialty Name
`207L00000X`	Anesthesiology
`207LA0401X`	Pain Medicine (Anesthesiology)
`207LP2900X`	Pediatric Anesthesiology

Specialties Represented:
- Anesthesiology: General anesthesia services.
- Pain Medicine (Anesthesiology): Focused on pain management during procedures.
- Pediatric Anesthesiology: Specialized care for pediatric patients undergoing anesthesia.

Related Diagnoses

M75.100: Unspecified rotator cuff tear or rupture of unspecified shoulder
- Relevant for patients with shoulder injuries requiring surgical intervention, potentially involving upper leg procedures if part of a multi-site operation.
S43.401A: Sprain of unspecified acromioclavicular joint, initial encounter
- Indicates acute shoulder injury; may be associated with trauma cases where multiple sites are addressed.
M19.011: Primary osteoarthritis, right shoulder
- Represents degenerative joint disease; relevant if the patient has comorbidities affecting surgical planning.
M19.012: Primary osteoarthritis, left shoulder
- Similar to M19.011, but affecting the left shoulder.
S42.001A: Fracture of unspecified part of right clavicle, initial encounter
- Indicates acute fracture; may be relevant in trauma cases requiring anesthesia for upper leg procedures as part of comprehensive care.

Related CPT Codes

01202: Under Anesthesia for Procedures on the Upper Leg (Except Knee) – arthroscopic procedure of the hip joint.
- Used when the procedure involves arthroscopy of the hip joint, requiring anesthesia services similar to 01200.
01250: Under Anesthesia for Procedures on the Upper Leg (Except Knee) – procedure on nerves, muscles, tendons, fascia, and bursae of the upper leg.
- Used for procedures targeting nerves, muscles, tendons, fascia, or bursae in the upper leg, which may require anesthesia services.

Clinical Relationship:

01202 and 01250 are related to 01200 as they all involve anesthesia for upper leg procedures, excluding the knee.
These codes may be used as alternatives depending on the specific surgical intervention performed.
It is uncommon to use these codes together for a single procedure; typically, one is selected based on the operative site and technique.

National Reimbursement Benchmarks

National mean rates for CPT code 01200 show that Blue Cross Blue Shield and Cigna have the highest average reimbursement, at $223.37 and $248.08 respectively, while UnitedHealth Group is notably lower at $65.66. The BUCA (average commercial) mean rate stands at $130.75, which is significantly higher than UnitedHealth Group but well below Cigna and Blue Cross Blue Shield. Medicare rates are not available in the input.

Rate dispersion varies considerably across payers. Cigna exhibits the widest spread, with a difference of $259.00 between its 75th and 25th percentiles, indicating substantial variability in reimbursement. In contrast, UnitedHealth Group has the tightest range, with only $25.67 separating its 75th and 25th percentiles, suggesting more consistent rates. Blue Cross Blue Shield and Aetna also show notable dispersion, but less than Cigna.

The table and chart below present a detailed breakdown of national benchmarks for each payer.

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Alaska demonstrates a wide spread in reimbursement rates for CPT code 01200, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($298.50 minus $225.80 = $72.70), while Aetna and UnitedHealth Group have minimal spread ($72.00 to $72.00 and $72.00 to $76.00, respectively). This indicates that some payers in Alaska have tightly clustered rates, while others, like Blue Cross Blue Shield and BUCA, offer broader variability.

Compared to national averages, Alaska's mean rates for most payers are higher, particularly for Blue Cross Blue Shield and Aetna. However, Cigna and UnitedHealth Group in Alaska pay less than their national mean rates. The table and chart below present the full breakdown of payer-specific rates in Alaska.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer in Alaska for CPT 01200, with a mean rate of $267.04.
UnitedHealth Group offers the lowest mean rate at $75.12, significantly below both state and national averages.
Alaska's mean rates for most payers are notably higher than national benchmarks, except for Cigna and UnitedHealth Group, which are lower.

CPT 01210: Anesthesia for Open Hip Joint Procedures

01215-ANESTHESIA-FOR-OPEN-PROCEDURES-INVOLVING-HIP-JOINT-REVISION

CPT 01215: Anesthesia for Revision of Total Hip Arthroplasty

01250-ANESTHESIA-FOR-PROCEDURES-ON-THE-SHOULDER-AND-AXILLA-NOT

CPT 01250: Anesthesia for Shoulder and Axilla Procedures

01230-ANESTHESIA-FOR-OPEN-PROCEDURES-INVOLVING-UPPER-TWOTHIRDS-OF

CPT 01230: Anesthesia for Open Procedures Involving Upper Two-Thirds of Femur

01212-ANESTHESIA-OPEN-PX-HIP-JOINT-HIP

CPT 01212: Anesthesia for Open Hip Joint Procedures, Hip Disarticulation

01202-ANESTHESIA-FOR-PROCEDURES-ON-THE-SHOULDER-AND-AXILLA-NOT

CPT 01202: Anesthesia for Shoulder and Axilla Procedures

01270-ANESTHESIA-FOR-PROCEDURES-ON-THE-UPPER-LEG-EXCEPT

CPT 01270: Anesthesia for Upper Leg Procedures (except knee)

01260-ANES-VEINS-OF-UPPER-LEG-INCLUDING

CPT 01260: Anesthesia for Veins of Upper Leg Including Exploration

01274-ANESTHESIA-FOR-PROCEDURES-INVOLVING-ARTERIES-OF-UPPER-LEG

CPT 01274: Anesthesia for Upper Leg Artery Procedures, Bypass Graft & Embolectomy

01220-ANESTHESIA-FOR-PROCEDURES-ON-THE-KNEE-JOINT

CPT 01220: Anesthesia for Knee Arthroscopy Procedures

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OpenPayer

Summary & Overview

CPT 01200: Anesthesia for Upper Leg Procedures (Except Knee)

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

OpenPayer

Summary & Overview

CPT 01200: Anesthesia for Upper Leg Procedures (Except Knee)

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes