CPT 01210 Reimbursement Benchmarks | OpenPayer

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.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 01210anesthesiologyhip surgeryoutpatient hospitalmedical billinganesthesia servicesprocedure codingpolicy updateclinical benchmarksopen hip procedures

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

Modifiers:

Modifier Code Description
QS Monitored anesthesia care service
QX CRNA service with medical direction by a physician
- Modifier QS is used when the anesthesia service is provided as monitored anesthesia care.

Modifier Code	Description
`QS`	Monitored anesthesia care service
`QX`	CRNA service with medical direction by a physician

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: Alaska1 / 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.

Related Codes

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

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

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

01214-ANESTHESIA-FOR-OPEN-PROCEDURES-INVOLVING-HIP-JOINT-TOTAL

CPT 01214: Anesthesia for Total Hip Arthroplasty

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

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

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

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

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

CPT 01202: Anesthesia for Shoulder and Axilla Procedures

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

CPT 01260: Anesthesia for Veins of Upper Leg Including Exploration

01234-ANESTHESIA-FOR-OPEN-PROCEDURES-INVOLVING-UPPER-TWOTHIRDS-OF

CPT 01234: Anesthesia for Radical Resection of Upper Femur

01200-ANESTHESIA-FOR-PROCEDURES-ON-THE-UPPER-LEG-EXCEPT

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

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Provider Taxonomies:

Taxonomy Code	Specialty Name
`207L00000X`	Anesthesiology
`367H00000X`	Anesthesiologist Assistant
`367500000X`	Certified 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.

OpenPayer

Summary & Overview

CPT 01210: Anesthesia for Open Hip Joint Procedures

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes

Related Diagnoses

Related CPT Codes

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes