Summary & Overview
CPT 01382: Anesthesia for Diagnostic Arthroscopy of the Knee Joint
CPT code 01382 covers anesthesia for diagnostic arthroscopic procedures of the knee joint, a common minimally invasive technique used to evaluate knee conditions. This code is nationally relevant for hospitals and ambulatory surgery centers performing outpatient knee arthroscopies, ensuring proper billing and reimbursement for anesthesia services. The publication examines coverage and policy details from major commercial payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
Readers will gain insight into payer-specific coverage, typical clinical scenarios, and billing practices associated with CPT code 01382. The summary includes benchmarks for utilization, policy updates, and clinical context, such as the types of knee diagnoses commonly associated with this procedure. The publication also highlights relevant modifiers, provider taxonomies, and related CPT codes, offering a comprehensive overview for stakeholders in anesthesia and orthopedic care. This information is valuable for understanding national trends in anesthesia billing for knee arthroscopy and staying informed about payer requirements and clinical documentation standards.
CPT Code Overview
CPT code 01382 is used to report anesthesia services for diagnostic arthroscopic procedures of the knee joint. This code applies specifically to cases where anesthesia is administered to facilitate minimally invasive diagnostic evaluation of the knee using arthroscopy. The service type is anesthesia, and the typical site of service is an outpatient hospital (Place of Service 22). This code is essential for accurately documenting and billing anesthesia care provided during these diagnostic procedures.
Clinical & Coding Specifications
Clinical Context
A patient presents to the outpatient hospital with persistent knee pain or instability, often due to conditions such as chronic instability, osteoarthritis, or localized knee pain. The orthopedic surgeon recommends a diagnostic arthroscopic procedure to evaluate the internal structures of the knee joint. An anesthesiologist provides anesthesia services for the procedure, ensuring patient comfort and safety throughout. The anesthesia is typically administered in an outpatient hospital setting (Place of Service 22), and the patient is monitored during the procedure. Common scenarios include patients with unilateral primary osteoarthritis or chronic instability who require further diagnostic evaluation before definitive treatment.
Coding Specifications
-
Modifier
QS: Indicates that monitored anesthesia care (MAC) was provided during the procedure. Used when the anesthesiologist is present and monitoring the patient, but not providing general anesthesia. -
Modifier
P1: Designates the patient as a normal, healthy individual with no systemic disease. Used to indicate the physical status of the patient for anesthesia coding.
| Modifier Code | Description |
|---|---|
QS | Monitored anesthesia care service |
P1 | A normal healthy patient |
- Provider Taxonomies:
| Taxonomy Code | Specialty |
|---|---|
207L00000X | Anesthesiology |
207LA0401X | Pain Medicine Anesthesiologist |
207RA0401X | Pain Medicine Physician |
These taxonomies represent providers specializing in anesthesia and pain management, who are qualified to deliver anesthesia services for knee arthroscopy.
Related Diagnoses
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M23.50- Chronic instability of knee, unspecified knee- Indicates ongoing instability of the knee joint, which may necessitate diagnostic arthroscopy to assess ligament or structural integrity.
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M25.561- Pain in right knee- Represents localized pain in the right knee, often prompting diagnostic evaluation via arthroscopy.
-
M25.562- Pain in left knee- Represents localized pain in the left knee, which may require arthroscopic investigation.
-
M17.11- Unilateral primary osteoarthritis, right knee- Refers to degenerative changes in the right knee joint, commonly leading to arthroscopic assessment for diagnosis and treatment planning.
-
M17.12- Unilateral primary osteoarthritis, left knee- Refers to degenerative changes in the left knee joint, which may be evaluated through diagnostic arthroscopy.
Each diagnosis is clinically relevant as it represents common indications for performing a diagnostic arthroscopic procedure of the knee joint, for which anesthesia services are coded with 01382.
Related CPT Codes
-
01380- Anesthesia for procedures on the knee joint- Used for anesthesia services during various surgical procedures on the knee joint. May be used as an alternative to
01382when the procedure is not specifically arthroscopic or diagnostic.
- Used for anesthesia services during various surgical procedures on the knee joint. May be used as an alternative to
-
01390- Anesthesia for closed procedure of the upper end of the tibia, fibula, and/or patella- Used for anesthesia during closed procedures involving the upper tibia, fibula, or patella. This code is related when the procedure involves these structures but is not an arthroscopic diagnostic procedure.
01380 and 01390 are related to 01382 in that they all pertain to anesthesia for knee and adjacent joint procedures. They may be used as alternatives depending on the specific surgical approach and structures involved. These codes are not typically billed together for the same procedure but may be selected based on the operative technique.
National Reimbursement Benchmarks
For CPT code 01382, the national mean rate for BUCA (average commercial) is $107.33, while Medicare data is not available in the input. Among the major commercial payers, Cigna has the highest mean rate at $197.80, followed by Blue Cross Blue Shield at $178.94, and Aetna at $132.50. UnitedHealth Group has the lowest mean rate at $65.55.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Cigna shows the widest spread ($173.42), indicating greater variability in contracted rates, while UnitedHealth Group has the tightest range ($24.75), suggesting more consistent reimbursement levels. Blue Cross Blue Shield and Aetna also display substantial dispersion, with ranges of $92.25 and $175.43, respectively.
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 01382, particularly with Blue Cross Blue Shield, where the difference between the 75th and 25th percentiles is $91.47. BUCA also shows a notable spread of $91.21, while Aetna and UnitedHealth Group have minimal spreads, indicating less variability in their reimbursement rates. Compared to national averages, Alaska's mean rates for most payers are significantly higher, especially for Blue Cross Blue Shield and BUCA, highlighting the state's elevated reimbursement environment.
The table and chart below present the full breakdown of mean rates and percentile values for each payer in Alaska, offering a clear comparison of reimbursement levels across the major commercial insurers.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 01382 in Alaska, with a mean rate of $219.37.
- UnitedHealth Group offers the lowest mean rate at $74.78.
- Alaska's mean rates for most payers are notably higher than national averages, especially for Blue Cross Blue Shield and BUCA.
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.