CPT 01390: Anesthesia for Closed Procedures of the Upper Tibia, Fibula, or Patella - OpenPayer

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Summary & Overview

CPT 01390: Anesthesia for Closed Procedures of the Upper Tibia, Fibula, or Patella

CPT code 01390 is a critical billing code for anesthesia services provided during closed procedures on the upper end of the tibia, fibula, and/or patella, typically involving the knee and popliteal area. This code is widely used in surgical settings, including hospital operating rooms and ambulatory surgery centers, to ensure accurate reimbursement for anesthesia care during orthopedic interventions. Nationally, the code is recognized by major payers such as Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, making it relevant for providers and facilities across the country.

This publication offers a comprehensive overview of 01390, including its clinical context, typical sites of service, and payer coverage. Readers will gain insights into the code’s role in orthopedic surgery, learn about common billing practices, and understand how it fits within the broader landscape of anesthesia coding. The article also highlights related codes and modifiers, providing clarity on distinctions between similar anesthesia services. Policy updates and benchmarks are discussed to inform stakeholders about current trends and requirements in medical billing for anesthesia. The summary is designed to equip healthcare professionals, administrators, and policy analysts with the essential information needed to navigate the complexities of anesthesia billing for knee procedures.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareCPT 01390anesthesiaorthopedic surgeryknee proceduresmedical billingsurgical settingprocedural codingpolicy updatesclinical contextbenchmarking

CPT Code Overview

CPT code 01390 is used to report anesthesia services for closed procedures involving the upper end of the tibia, fibula, and/or the patella. These procedures are typically performed on the knee and popliteal area. The service type is anesthesia, and it is most commonly provided in a surgical or procedural setting, such as a hospital operating room (POS 22) or an ambulatory surgery center (POS 24). This code ensures proper documentation and billing for anesthesia care during these specific orthopedic interventions.

Clinical & Coding Specifications

Clinical Context

A patient presents with knee pain and functional limitation due to conditions such as unilateral primary osteoarthritis or chronic instability. After evaluation by an orthopedic surgeon, a closed surgical procedure is scheduled on the upper end of the tibia, fibula, and/or patella. The procedure is performed in a hospital operating room or ambulatory surgery center. An anesthesia provider, such as an anesthesiologist or certified registered nurse anesthetist, administers anesthesia services for the duration of the closed procedure, ensuring patient comfort and safety throughout the surgical workflow.

Coding Specifications

Common Modifiers:

Modifier Code	Description	When Used
`QS`	Monitored anesthesia care service	Used when the anesthesia provider delivers monitored anesthesia care during the procedure.
`QX`	CRNA service with medical direction by a physician	Used when a certified registered nurse anesthetist provides anesthesia services under the medical direction of a physician.

National Reimbursement Benchmarks

National mean rates for CPT code 01390 show that Cigna has the highest average reimbursement at $197.88, while UnitedHealth Group is the lowest among commercial payers at $65.49. The BUCA (average commercial) mean rate is $106.37, which is notably higher than UnitedHealth Group but lower than Blue Cross Blue Shield and Cigna. Medicare rates are not available in the input for comparison.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Aetna exhibits the widest spread at $190.00, indicating substantial variability in contracted rates. In contrast, UnitedHealth Group has the tightest range at $25.00, suggesting more consistent reimbursement levels. Blue Cross Blue Shield and Cigna also show considerable dispersion, with ranges of $81.00 and $173.00, 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 exhibits a wide spread in reimbursement rates for CPT code 01390, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($91.47), while Aetna and UnitedHealth Group have minimal spread ($0 to $3). This indicates significant variability in negotiated rates among payers, with some offering highly consistent rates and others much broader ranges.

Compared to national averages, Alaska's mean rates for most payers are substantially higher, particularly for Blue Cross Blue Shield and BUCA. The table and chart below present the full breakdown of payer-specific rates and percentiles for Alaska, highlighting these differences and the overall landscape for CPT code 01390 in the state.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 01390 in Alaska, with a mean rate of $219.25.
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.

Related Codes

01712

CPT 01712: Anesthesia for Upper Arm and Elbow Procedures

01360

CPT 01360: Anesthesia for Procedures on the Knee and Popliteal Area

01522

CPT 01522: Anesthesia for Total Knee Arthroplasty

01270

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

01320

CPT 01320: Anesthesia for Knee and Popliteal Area Procedures

01215

CPT 01215: Anesthesia for Revision of Total Hip Arthroplasty

01654

CPT 01654: Anesthesia for Lower Leg Procedures, Not Otherwise Specified

01340

CPT 01340: Anesthesia for Closed Procedures on Lower Third of Femur

01214

CPT 01214: Anesthesia for Total Hip Arthroplasty

01462

CPT 01462: Anesthesia for Open Bone Procedures of Lower Leg/Ankle/Foot

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