CPT 01234: Anesthesia for Radical Resection of Upper Femur - OpenPayer

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Summary & Overview

CPT 01234: Anesthesia for Radical Resection of Upper Femur

CPT code 01234 represents anesthesia for open procedures involving the upper two-thirds of the femur, specifically for radical resection. This code is significant in the national healthcare landscape due to its application in complex orthopedic surgeries that require advanced anesthesia management. The publication covers key payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, providing a comprehensive overview of payer coverage and policy considerations for this service.

Readers will gain insight into the clinical context of radical femur resection procedures, typical sites of service, and the role of anesthesia in supporting these high-acuity cases. The summary also highlights relevant billing modifiers, associated provider taxonomies, and common ICD-10 diagnoses linked to the procedure. Additionally, the publication offers benchmarks and policy updates that inform stakeholders about current trends and requirements for anesthesia billing in orthopedic surgery. This information is essential for understanding the complexities of coding, reimbursement, and payer policies related to anesthesia services for radical femur resection.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 01234anesthesiaorthopedic surgeryinpatient hospitalradical resectionmedical billingprocedure codingclinical benchmarkspolicy updatesservice line

CPT Code Overview

CPT code 01234 is used to report anesthesia services for open procedures involving the upper two-thirds of the femur, specifically for radical resection. This code is classified under the anesthesia service type and is most commonly performed in an inpatient hospital setting (Place of Service 21). The procedure typically involves complex surgical intervention requiring specialized anesthesia care to ensure patient safety and comfort during radical resection of the femur.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult admitted to an inpatient hospital for a radical resection of the upper two-thirds of the femur. The patient may have a history of advanced osteoarthritis or complications related to a previous knee replacement. The surgical team, including an orthopedic surgeon, plans an open procedure to remove diseased or damaged bone tissue. Anesthesia services are provided throughout the operation, ensuring patient safety and comfort. The anesthesia provider may be an anesthesiologist or a certified registered nurse anesthetist (CRNA), and the procedure is performed in a hospital operating room setting.

Coding Specifications

Common Modifiers:

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

Modifier QS is used when monitored anesthesia care is provided.
Modifier QX is used when a CRNA delivers anesthesia services under the medical direction of a physician.

National Reimbursement Benchmarks

For CPT code 01234, national mean rates vary significantly across commercial payers. Cigna and Blue Cross Blue Shield have the highest mean rates at $454.82 and $426.26, respectively, while UnitedHealth Group is notably lower at $65.61. The BUCA average commercial mean rate is $191.52, which is substantially higher than typical Medicare rates for most codes, though Medicare-specific data is not available in the input.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, is widest for Cigna ($603.75) and Aetna ($428.00), indicating substantial variability in contracted rates. UnitedHealth Group shows the tightest range ($25.20), suggesting more consistent reimbursement levels. The table and chart below present the full breakdown of national benchmarks for each payer.

State Benchmarks

State: AK1 / 50

Alaska Benchmarks

Alaska exhibits a wide spread in reimbursement rates for CPT code 01234, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($163.15), while Aetna, Cigna, and UnitedHealth Group display minimal spreads ($3.00 or less). This indicates that Blue Cross Blue Shield's rates vary considerably across providers, whereas other payers maintain more consistent payment levels. The mean rates in Alaska are notably higher than national averages for most payers, particularly for Blue Cross Blue Shield and BUCA, highlighting Alaska's unique reimbursement landscape.

The table and chart below present the full breakdown of payer-specific rates for CPT code 01234 in Alaska, including mean values and percentile distributions. These details provide a clear comparison of how each payer compensates providers within the state.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer in Alaska for CPT 01234, with a mean rate of $509.64.
UnitedHealth Group offers the lowest mean rate at $74.78.
Alaska's mean rates for most payers are significantly higher than national averages, especially for Blue Cross Blue Shield and BUCA.

Related Codes

01382

CPT 01382: Anesthesia for Diagnostic Arthroscopy of the Knee Joint

01714

CPT 01714: Anesthesia for Tenoplasty Procedures, Upper Arm and Elbow

01442

CPT 01442: Anesthesia for Knee and Popliteal Area Procedures

01232

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

01636

CPT 01636: Anesthesia for Procedures on the Shoulder and Axilla

01782

CPT 01782: Anesthesia for Lower Leg, Ankle, and Foot Procedures

01634

CPT 01634: Anesthesia for Shoulder Disarticulation Procedures

01440

CPT 01440: Anesthesia for Knee and Popliteal Artery Procedures

01400

CPT 01400: Anesthesia for Knee Arthroscopic or Open Procedures

01712

CPT 01712: Anesthesia for Upper Arm and Elbow Procedures

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