Summary & Overview
CPT 01210: Anesthesia for Open Hip Joint Procedures
CPT code 01210 represents anesthesia services for open procedures of the hip joint that are not otherwise specified. This code is significant for hospitals and anesthesia providers nationwide, as it is commonly used in surgical cases requiring specialized anesthesia care for hip operations. The code is relevant across major commercial payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, making it a key billing code in outpatient hospital settings.
This publication provides a comprehensive overview of CPT code 01210, including its clinical context, typical site of service, and payer coverage. Readers will gain insights into the procedural scope, associated service line, and the importance of accurate coding for anesthesia in hip surgeries. The analysis also covers related codes, common modifiers, and associated taxonomies, offering a clear understanding of how this code fits within broader anesthesiology billing practices. Policy updates and benchmarks are discussed to help stakeholders stay informed about current trends and requirements for anesthesia billing in hip procedures. The information is designed to support healthcare professionals, administrators, and policy analysts in navigating the complexities of medical billing for anesthesia services.
CPT Code Overview
CPT code 01210 is used to report anesthesia services for open procedures involving the hip joint that are not otherwise specified. This code falls under the anesthesiology service type and is typically performed in an outpatient hospital setting (Place of Service 22). The procedure requires specialized anesthesia care to ensure patient safety and comfort during complex hip surgeries. Providers use this code to document and bill for anesthesia administration during these open hip joint operations.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting to an outpatient hospital setting with significant hip pain and functional limitation due to conditions such as osteoarthritis or chronic instability. The patient is scheduled for an open surgical procedure on the hip joint, which may include repair, reconstruction, or other interventions not otherwise specified. An anesthesiology provider evaluates the patient preoperatively, plans the anesthesia care, and administers anesthesia throughout the procedure, monitoring vital signs and ensuring patient safety until recovery.
Coding Specifications
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Modifiers:
Modifier Code Description QSMonitored anesthesia care service QXCRNA service with medical direction by a physician - Modifier
QSis used when the anesthesia service is provided as monitored anesthesia care. - Modifier
QXis used when a Certified Registered Nurse Anesthetist (CRNA) provides the service under physician medical direction.
- Modifier
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Provider Taxonomies:
Taxonomy Code Specialty Name 207L00000XAnesthesiology 367H00000XAnesthesiologist Assistant 367500000XCertified Registered Nurse Anesthetist - Anesthesiology (
207L00000X): Physicians specializing in anesthesia. - Anesthesiologist Assistant (
367H00000X): Non-physician anesthesia providers. - Certified Registered Nurse Anesthetist (
367500000X): Advanced practice nurses specializing in anesthesia.
- Anesthesiology (
Related Diagnoses
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M17.11- Unilateral primary osteoarthritis, right knee- Indicates degenerative joint disease affecting the right knee, which may be relevant if the patient has multiple joint involvement or is undergoing hip surgery due to compensatory changes.
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M17.12- Unilateral primary osteoarthritis, left knee- Similar to
M17.11, but affecting the left knee. May be clinically relevant in patients with widespread joint disease.
- Similar to
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S83.241A- Sprain of medial collateral ligament of right knee, initial encounter- Represents an acute injury to the right knee, possibly contributing to altered gait or hip stress, leading to hip surgery.
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S83.242A- Sprain of medial collateral ligament of left knee, initial encounter- Acute injury to the left knee, which may be associated with hip pathology due to biomechanical changes.
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M23.51- Chronic instability of knee, right knee- Chronic knee instability can affect mobility and may be associated with hip joint pathology requiring surgical intervention.
Related CPT Codes
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01212- ANESTHESIA OPEN PX HIP JOINT HIP DISARTICULATION- Used for anesthesia during open hip joint procedures involving hip disarticulation, which is a more extensive surgery than procedures coded with
01210.
- Used for anesthesia during open hip joint procedures involving hip disarticulation, which is a more extensive surgery than procedures coded with
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01214- ANESTHESIA OPEN PX TOTAL HIP ARTHROPLASTY- Used for anesthesia during open procedures for total hip arthroplasty, commonly performed for severe joint disease. May be used as an alternative to
01210when the procedure is specifically a total hip replacement.
- Used for anesthesia during open procedures for total hip arthroplasty, commonly performed for severe joint disease. May be used as an alternative to
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01215- ANESTHESIA OPEN PX REVISION TOT HIP ARTHROPLASTY- Used for anesthesia during revision of a total hip arthroplasty. This code is relevant when a prior hip replacement requires surgical revision. It is an alternative to
01210for revision cases.
- Used for anesthesia during revision of a total hip arthroplasty. This code is relevant when a prior hip replacement requires surgical revision. It is an alternative to
These codes are related to 01210 and are selected based on the specific surgical procedure performed. They are not typically used together but rather as alternatives depending on the clinical scenario.
National Reimbursement Benchmarks
National mean rates for CPT code 01210 show that BUCA (average commercial) is at $188.83, while Medicare rates are not available in the input. Among the commercial payers, Cigna has the highest mean rate at $350.71, and UnitedHealth Group is the lowest at $65.65.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. UnitedHealth Group exhibits the tightest range ($75.88 - $50.33 = $25.55), indicating less variability in rates. In contrast, Aetna and Cigna have the widest dispersions, with Aetna's range at $391.67 and Cigna's at $431.00, reflecting greater variability in contracted rates.
The table and chart below present the full breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska displays a significant rate spread for CPT code 01210, particularly with Blue Cross Blue Shield, where the 75th percentile ($523.00) is substantially higher than the 25th percentile ($323.20), resulting in a spread of $199.80. Other payers, such as Aetna and UnitedHealth Group, show minimal spread, with all percentiles clustered closely around $72.00, indicating limited variability in reimbursement rates. The overall mean rates for most payers in Alaska are notably higher than their national averages, especially for Blue Cross Blue Shield and BUCA, while Cigna and UnitedHealth Group remain below their national benchmarks.
The table and chart below present the full breakdown of mean rates and percentile distributions by payer for CPT code 01210 in Alaska, highlighting the differences in reimbursement levels across the major commercial payers.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 01210 in Alaska, with a mean rate of $415.84.
- UnitedHealth Group offers the lowest mean rate at $75.12.
- Mean rates for most payers in Alaska are higher than their respective national averages, except for Cigna and UnitedHealth Group, which are below national benchmarks.
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.