CPT 01215 Reimbursement Benchmarks & Policy | OpenPayer

Summary & Overview

CPT 01215: Anesthesia for Revision of Total Hip Arthroplasty

CPT code 01215 represents anesthesia for open procedures involving the hip joint, specifically for revision of total hip arthroplasty. This code is significant in the national healthcare landscape due to the increasing prevalence of hip replacement surgeries and the need for specialized anesthesia during complex revision procedures. The code is recognized by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, reflecting its widespread use and importance in hospital surgical settings.

This publication provides a comprehensive overview of CPT code 01215, including payer coverage, clinical context, and policy updates relevant to anesthesia services for hip revision surgeries. Readers will gain insights into typical sites of service, common billing practices, and the role of anesthesia in supporting surgical outcomes. The analysis also highlights related codes and modifiers, offering a clear understanding of how this procedure fits within broader anesthesiology and pain medicine practices. Benchmarks and regulatory considerations are discussed to inform stakeholders about current trends and requirements for reporting anesthesia services in hip revision cases.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 01215anesthesiahip revisionarthroplastyoperating roomhospital surgeryclinical codingpolicy updatepain medicineanesthesiology

CPT Code Overview

CPT code 01215 is used to report anesthesia services for open procedures involving the hip joint, specifically for revision of total hip arthroplasty. This code falls under Category I Anesthesia and is typically performed in an operating room setting, either in an inpatient or outpatient hospital surgical environment. The procedure requires specialized anesthesia care to support complex surgical interventions on the hip joint, ensuring patient safety and comfort during revision surgery.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult patient presenting with pain, dysfunction, or complications related to a previously implanted hip prosthesis. The patient is scheduled for a revision of a total hip arthroplasty due to issues such as loosening, infection, or mechanical failure. The procedure is performed in an operating room within an inpatient or outpatient hospital surgical setting. Anesthesia services are provided by an anesthesiologist or a certified registered nurse anesthetist (CRNA), often with medical direction by a physician. The clinical workflow includes preoperative assessment, administration of anesthesia, intraoperative monitoring, and postoperative care.

Coding Specifications

Modifiers:
- QS: Monitored anesthesia care service. Used when the anesthesia provider delivers monitored anesthesia care (MAC) during the procedure.
- QX: CRNA service with medical direction by a physician. Used when a CRNA provides anesthesia services under the medical direction of a physician.
Provider Taxonomies:

Taxonomy Code Specialty Description

National Reimbursement Benchmarks

National mean rates for CPT code 01215 show significant variation between commercial payers and Medicare. The average commercial rate (BUCA) is $237.14, while UnitedHealth Group, which is used as a proxy for Medicare in this context, has a much lower mean rate of $65.63.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies widely across payers. Blue Cross Blue Shield has the tightest range ($577.50 - $376.70 = $200.80), indicating more consistent rates. Cigna exhibits the widest dispersion ($865.00 - $89.33 = $775.67), reflecting substantial variability in contracted rates. Aetna and BUCA also show broad ranges, while UnitedHealth Group's rates are relatively close together.

The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Alaska displays a substantial rate spread for CPT code 01215, particularly with Blue Cross Blue Shield, where the 75th percentile ($726.25) is $208.25 higher than the 25th percentile ($518.00). In contrast, Aetna, Cigna, and UnitedHealth Group show minimal rate variation, with their 25th and 75th percentiles tightly clustered around $72–$93. Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and Aetna are significantly higher, while Cigna and UnitedHealth Group remain below national means.

The table and chart below present the full breakdown of payer-specific reimbursement rates for CPT code 01215 in Alaska, highlighting the pronounced differences between payers and the unique regional landscape.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 01215 in Alaska, with a mean rate of $630.97.
UnitedHealth Group offers the lowest mean rate at $75.12, significantly below both state and national averages.
The rate spread in Alaska is notably wider than national benchmarks, with BCBS rates far exceeding the national mean for this code.

CPT 01220: Anesthesia for Knee Arthroscopy Procedures

01272-UNDER-ANESTHESIA-FOR-PROCEDURES-ON-THE-UPPER-LEG-EXCEPT

CPT 01272: Anesthesia for Upper Leg Vascular Procedures (Femoral Artery)

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

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

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

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

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

01232-UNDER-ANESTHESIA-FOR-PROCEDURES-ON-THE-UPPER-LEG-EXCEPT

CPT 01232: Anesthesia for Upper Leg Procedures (Except Knee)

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

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

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

CPT 01202: Anesthesia for Shoulder and Axilla Procedures

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

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

Showing 1–10 of 14

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.

OpenPayer

Summary & Overview

CPT 01215: Anesthesia for Revision of Total Hip Arthroplasty

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