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

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Summary & Overview

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

CPT code 01272 is a critical billing code used to report anesthesia services for procedures on the upper leg, excluding the knee, with a focus on ligation and bypass graft placement of the femoral artery. This code is nationally relevant for hospitals and anesthesia providers, as it ensures proper documentation and reimbursement for complex vascular interventions. The publication covers major commercial payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, providing a comprehensive overview of payer coverage and policy considerations.

Readers will gain insight into the clinical context of 01272, including its typical use in hospital outpatient and inpatient settings. The summary highlights benchmarks, policy updates, and the importance of accurate coding for anesthesia services in vascular surgery. The article also addresses common modifiers, associated taxonomies, and relevant ICD-10 diagnoses, offering a well-rounded perspective for healthcare professionals and billing specialists. By understanding the nuances of 01272, stakeholders can stay informed about national trends and requirements for anesthesia billing in upper leg vascular procedures.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 01272anesthesiavascular surgeryupper leg procedureshospital outpatienthospital inpatientfemoral arterymedical billingclinical codingpolicy updates

CPT Code Overview

CPT code 01272 is designated for anesthesia services provided during procedures on the upper leg, excluding the knee. Specifically, this code applies to cases involving ligation and bypass graft placement of the femoral artery. The service type is anesthesia, and it is typically performed in a hospital outpatient or inpatient setting under Part A PPS services. This code is essential for accurately reporting and reimbursing anesthesia care associated with complex vascular procedures on the upper leg.

Clinical & Coding Specifications

Clinical Context

A patient presents to the hospital with a vascular condition requiring surgical intervention on the upper leg, such as ligation or bypass graft placement of the femoral artery. The procedure is performed in a hospital outpatient or inpatient setting. An anesthesia provider, such as an anesthesiologist, anesthesiology assistant, or certified registered nurse anesthetist, administers anesthesia services to ensure patient comfort and safety during the operation. The clinical workflow involves preoperative assessment, induction and maintenance of anesthesia, intraoperative monitoring, and postoperative care. Common clinical scenarios include patients with arterial blockages, trauma, or vascular disease affecting the femoral artery, often associated with pain, fractures, or sprains in the lower extremities.

Coding Specifications

Modifiers:
- QS: Monitored anesthesia care service. Used when the anesthesia provider delivers monitored anesthesia care rather than general anesthesia.
- QX: CRNA service with medical direction by a physician. Used when a certified registered nurse anesthetist provides anesthesia under the medical direction of a physician.
Provider Taxonomies:

Taxonomy Code Specialty Name

National Reimbursement Benchmarks

National mean rates for CPT code 01272 show that Cigna and Blue Cross Blue Shield have the highest average reimbursement, at $249.04 and $233.56 respectively, while UnitedHealth Group is notably lower at $65.55. The BUCA (average commercial) mean rate stands at $120.17, which is significantly higher than typical Medicare rates, though Medicare data is not available in the input for this code.

Rate dispersion varies considerably across payers. UnitedHealth Group has the tightest range between the 25th and 75th percentiles ($75.29 - $50.17 = $25.12), indicating less variability in contracted rates. In contrast, Cigna exhibits the widest spread ($348.00 - $89.00 = $259.00), reflecting substantial variation in reimbursement levels. Blue Cross Blue Shield and Aetna also show broad ranges, suggesting diverse contract terms across providers.

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

State Benchmarks

State: AK1 / 50

Alaska Benchmarks

Alaska demonstrates a substantial rate spread for CPT code 01272, particularly with Blue Cross Blue Shield, where the difference between the 75th and 25th percentiles is $72.70 ($298.50 minus $225.80). Other payers, such as Aetna and UnitedHealth Group, show minimal spread, with all percentiles clustered closely around $72.00 to $75.00, indicating limited variability in reimbursement rates. Cigna also exhibits a narrow spread, with rates ranging from $85.00 to $93.00.

Compared to national averages, Alaska's mean rates for Aetna and Blue Cross Blue Shield are notably higher, while Cigna's mean rate is much lower than its national benchmark. The table and chart below present the full breakdown of payer-specific reimbursement rates for CPT code 01272 in Alaska.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 01272 in Alaska, with a mean rate of $267.13.
UnitedHealth Group offers the lowest mean rate in Alaska at $74.78.
Alaska's mean rates for most payers are higher than their respective national averages, except for Cigna, which is significantly lower in Alaska compared to its national mean.

Related Codes

01638

CPT 01638: Anesthesia for Shoulder and Axilla Procedures

01260

CPT 01260: Anesthesia for Veins of Upper Leg Including Exploration

01742

CPT 01742: Anesthesia for Upper Arm and Elbow Procedures

01382

CPT 01382: Anesthesia for Diagnostic Arthroscopy of the Knee Joint

01670

CPT 01670: Anesthesia for Procedures on the Shoulder and Axilla

01732

CPT 01732: Anesthesia for Diagnostic Elbow Arthroscopy

01634

CPT 01634: Anesthesia for Shoulder Disarticulation Procedures

01482

CPT 01482: Anesthesia for Radical Resection of Lower Leg, Ankle, and Foot

01430

CPT 01430: Anesthesia for Knee Joint Procedures, Not Otherwise Specified

01220

CPT 01220: Anesthesia for Knee Arthroscopy Procedures

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